Good Faith Estimate — Your Rights Under the No Surprises Act

Your right to a Good Faith Estimate

Under the federal No Surprises Act, health care providers must give patients who do not have insurance — or who choose not to use their insurance — an estimate of the expected charges for medical services, in writing, before those services are provided. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency service, including office visits, procedures, and related fees.

When you will receive one

We will provide a Good Faith Estimate in writing at least one business day before a scheduled service (or within the timeframes required by law based on when the service is scheduled). You can also ask for an estimate at any time before scheduling — just ask our front desk or call the office.

If your bill is higher than the estimate

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill through the federal patient-provider dispute resolution process. Keep a copy of your estimate — you may need it.

Questions

For questions about your estimate, or to request one, call us at (386) 217-6556. For more information about your rights under the No Surprises Act, visit www.cms.gov/nosurprises.

Effective date: August 2026. This document is reviewed periodically and may be updated. Questions? Call (386) 217-6556.