Notice: Availability Of Good Faith Estimate

If you are uninsured, or you do not wish to submit a bill for your care to your insurance plan for your care, then you have a right to receive an estimate of your bill before receiving any health care items or services.

• When scheduling your appointment, we will ask you if you have insurance or how you wish to pay. If you do not have insurance, or if you wish to pay on your own without insurance, then you will be given a good-faith estimate for the costs of the services we anticipate providing to you.
• The estimate will include the total expected cost for all items or services that we reasonably expect to provide to you at the time of scheduling.
• If you schedule at least 10 days in advance, we will deliver a good-faith estimate to you within 3 days of scheduling. If you schedule at least 3 days in advance, we will deliver a good-faith estimate to you within l day of scheduling. If you schedule less than 3 days in advance, you may not receive a good-faith estimate prior to your appointment.
• You may also request an estimate at any time. We will return a good faith estimate within 3 days of your request.
• Make sure to save a copy or picture of your estimate and the bill.
• If you receive a bill that is at least $400 more than your estimate, you can dispute the bill by visiting www.cms.gov/nosurprises/consumers.

For questions or more information about your right to a good faith estimate, please visit www.crns.gov/nosurprises/consumers, email [email protected], or call 1-800-985-3059.