Good Faith Estimate

You have the right to a written estimate of your medical bill (called a Good Faith Estimate) when: (a) Your appointment is scheduled 3 or more days in advance and you will not be using insurance to pay for the visit, (b) You do not have insurance, (c) You are a Self-Pay patient. You may also request an estimate if one is not automatically provided. The Good Faith Estimate will include the expected charges of the item or service, such as: the cost of the non-emergent appointment, plus any tests, procedures, and supplies. As a service to you, we provide a fee schedule for all of our patients to view so they know the Good Faith Estimate for all services which is located in the Intelligent Health Practice Policies and on the company's website. Make sure to save a copy or photo of this Good Faith Estimate document. If you receive a bill from us that is at least $400 more than your estimate, you can dispute it. This must be done within 120 calendar days of receiving the bill. For more information about your rights and the No Surprise Bill Act, visit: www.cms.gov/nosurprises or call 1-877-696-6775