Fees for Service

Information on The Federal "No Surprises Act" and “Good Faith Estimate” Requirement

[The following information is provided here to fulfill this provider’s obligation to explicitly inform patients about this law, and any potential implications the law has for the cost of their care. Since this practice’s fees are explicitly posted on this public website, this practice has already taken the necessary steps to ensure patients are informed of the costs of their services and are not ever faced with a surprise fee. The following information is posted to fulfill this regulatory requirement.]

The Federal ‘No Surprises Act’ took effect on January 1, 2022. Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance a Good Faith 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. (The fee schedule published on this website describes the fees for all services so that when scheduling an appointment the patient knows what the cost will be). This does not include any unknown or unexpected costs that arise during treatment, but this is an exceptionally rare occurrence. You could be charged more if complications or special circumstances occur, but this will be communicated at the soonest appropriate time and is exceptionally rare.

You can ask your healthcare provider(s) for a Good Faith Estimate before you schedule any item or service.

If you are billed for more than the Good Faith Estimate of medical costs,

You have a right to dispute the bill

You can ask the provider for an updated bill to match the Good Faith Estimate

You can ask to negotiate the bill

You can ask if there is financial assistance available

You have a right to initiate a patient-provider dispute resolution process with the US Department of Health and Human Services if the actual billed charges substantially exceed (by at least $400) the expected charges included in the Good Faith Estimate.

If you choose this route, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill

There is a $25 fee to use the dispute process

If the agency reviewing your dispute agrees with you, you will have to pay the price of the Good Faith Estimate

If the agency reviewing your dispute disagrees with you and agrees with the provider, you will have to pay the higher amount

The initiation of a patient-provider dispute resolution process will not adversely affect the quality of healthcare services furnished to you.

Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 866-226-1819.

There may be additional items or services the provider may recommend as part of the course of care that must be scheduled or requested separately and are not reflected in the Good Faith Estimate.  Upon request, the Good Faith Estimate can be updated.

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

The Good Faith Estimate is not a contract and does not require the uninsured (or self-pay) individual to obtain the items or services from the provider, nor compel the provider to provide these services.