Good Faith Estimates

The No Surprises Act went into effect January 1, 2022 which requires us to provide a Good Faith Estimate of the costs of care.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services, and the estimate does not obligate or require you to obtain any of the listed services from this practice.

• We provide our Good Faith Estimate in the Policies and Disclosure Document given to patient prior to becoming a patient and update patients as necessary.

• The information provided in the Good Faith Estimate is only an estimate, as actual items, services, or charges may differ.

• We may recommend additional items or services as part of the treatment that are not reflected in the estimate. These would need to be scheduled separately.

• You have a right to engage in a dispute resolution process if the actual costs of services significantly exceed those listed in the Good Faith Estimate.

• Make sure to save a copy of the Good Faith Estimate policies by keeping the Policies and Disclosure document.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call