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Good Faith Estimates

The No Surprises Act was passed at the end of 2020 as a part of the Consolidated Appropriations Act of 2021 and went into effect on January 01, 2022. One of the major goals is to ensure that uninsured or self-pay patients do not receive health care bills that far exceed their awareness or expectations.

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The rules define uninsured (or self-pay) individual to mean an individual who does not have health insurance benefits. Or, an individual with health insurance, but their health insurance does not cover the item or service. For our Medicare patients, this would include your exam fee, extremity adjusting fee, or certain modalities or therapies.

*Note, that if you have a high deductible plan and your services go towards meeting your deductible, is not considered self pay.

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Regardless of your insurance status, please note- our office is always happy to provide you with an estimate of your costs upon your request. We are always happy to discuss your insurance benefits and coverage with you as well.

 

If your bill is higher than your Good Faith Estimate, you may have the right to dispute your bill.

 

  • A Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment.You could be charged more if complications or special circumstances occur. If this happens, and your bill is $400 or more than your Good Faith Estimate, federal law allows you to dispute the bill.

  • You can contact us, let us know the billed charges are higher than the Good Faith Estimate, and ask us to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

  • You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (approximately four months) of the date on the original bill.

    • If you dispute your bill, we cannot move the bill for the disputed item or service into collection or threaten to do so, or if the bill has already moved into collection, we are required to cease collection efforts. We must also suspend the accrual of any late fees on unpaid bill amounts until after the dispute resolution process has concluded. We also cannot take or threaten to take any retributive action against you for disputing your bill.

    • There is a $25 fee to use the dispute process. If the Selected Dispute Resolution (SDR) entity reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate, reduced by the $25 fee. If the SDR entity disagrees with you and agrees with us, you will have to pay the higher amount.

    • To learn more and get a form to start the process, go to www.cms.gov/nosurprises/consumers or call 1-800-985-3059.

    • For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-
      800-985-3059.


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

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