Good Faith Estimate

In compliance with the No Surprises Act that went into effect January 1, 2022, we are required
to notify all healthcare consumers of their Federal rights and protections against “surprise

This Act requires that we notify individuals of their federally protected rights to receive a notification
when services are rendered by a non-participating provider and provide options to receive care
from an in-network provider if one is available.

Each provider at this office is contracted with different insurance companies. We will notify you prior to your appointment whether your provider is in-network or out of network with your specific insurance plan. If you choose to meet with a provider who is out of network (not covered by your insurance plan), we will provide you with a good faith estimate of the proposed services both verbally and in writing prior to your first appointment. 

  1. We will begin by asking if you have any kind of health insurance coverage (including government insurance programs like Medicare, Medicaid, or Tricare), and if so, whether you intend to submit a claim to that insurance for the service.

2. We will Inform all uninsured and self-pay patients that a good faith estimate of expected charges is

  • available in a written document that is clear, understandable, and prominently displayed;
  • orally provided when the service is scheduled or when the patient asks about costs; and
  • available in accessible formats, and in the language(s) spoken by the patient.

3. We will provide a good faith estimate of expected charges for a scheduled or requested service, including items or services that are reasonably expected to be provided in conjunction with such scheduled or requested item or service.

For more information, click on these links:

Notice of Disclosure Regarding Surprise Billing

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