Good Faith Estimate.

Your Right to a Good Faith Estimate

You have the right to receive a Good Faith Estimate explaining how much your medical care will cost. Under the law, health care providers must give patients who do not have insurance, or who are not using insurance, an estimate of the expected charges for medical items and services.

This estimate covers non-emergency items and services, which may include the visit, exam, and any related treatment we expect to provide. Our current self-pay session rates are published on our Services & Pricing page, and a Good Faith Estimate puts those into a written estimate for your expected course of care.

How to Get Your Estimate

• You can ask us for a Good Faith Estimate before you schedule an item or service.
• If you schedule an item or service at least 3 business days in advance, we will give you a Good Faith Estimate in writing within 1 business day of scheduling.
• Make sure to save a copy or photo of your Good Faith Estimate.

The estimate is only an estimate; the actual items, services, or charges may differ from what is included in the Good Faith Estimate.

If Your Bill Is Higher Than Your Estimate

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill. You may contact us to let us know the billed charges are higher than the estimate, and you can ask us to update the bill, negotiate, or ask about financial assistance.

You may also start a federal patient-provider dispute resolution process. You must start the dispute process within 120 calendar days of the date on your original bill. There is a small fee to use the dispute process; if the dispute resolution entity agrees with you, you will have to pay the amount on the estimate.

For More Information

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit cms.gov/nosurprises or call 1-800-985-3059.

To request a Good Faith Estimate from our practice, contact us:

This notice describes your rights under the No Surprises Act. It is not a bill and is not itself a Good Faith Estimate.