No Surprises Act & Good Faith Estimate Notice

Your Rights Under the No Surprises Act

You have the right to receive a Good Faith Estimate explaining how much your medical care will cost if you do not have insurance or if you choose not to use your insurance.

Under federal law, healthcare providers are required to give patients who are uninsured or self-pay an estimate of expected charges for medical services. This estimate is based on the information known at the time and may not include all potential services or charges.

For more information about your rights under the No Surprises Act, visit:

https://www.cms.gov/nosurprises

This notice is provided in compliance with the federal No Surprises Act.

  • A Good Faith Estimate is an expected cost of services that will be provided. If you schedule services at least three business days in advance, you can request a Good Faith Estimate prior to your visit.

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you may have the right to dispute the bill.

  • If you are uninsured or choosing not to use insurance and would like a Good Faith Estimate, please contact our office.

    Phone: 715-453-5365