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Good Faith Estimate

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Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” (GFE) of expected charges.

You have the right to receive a Good Faith Estimate explaining how much your medical care will cost.

The GFE shows the costs of items and services that are reasonably expected for services provided. The estimate is based on information known at the time the estimate was created.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

This estimate is not a contract. You are not obligated to receive services at this facility or by this provider. Our office can provide you alternative referrals at your request. 

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the 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 on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility you will have to pay the higher amount. 

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

Below is a schedule of fees for the most commonly used services:

90791 - Initial Diagnostic Evaluation ($200)
90837 - Individual Therapy ($175)