Know Your Rights

Under the No Surprises Act, you have the right to receive a Good Faith Estimate explaining how much your medical care will cost. This applies to patients who are uninsured or who are choosing to pay out-of-pocket (self-pay) instead of using their insurance benefits at the time of service.

What Is a Good Faith Estimate?

A Good Faith Estimate (GFE) outlines the expected cost of services. It includes:

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• The type of service (e.g., physical therapy evaluation, follow-up sessions)

• The estimated cost per session

• The total estimated cost of care based on your treatment plan

Please note: This is only an estimate, and not a guarantee of treatment outcome or duration. It is a financial estimate based on typical care patterns. Actual costs may vary depending on your individual needs and the progression of your care. The estimate is based on information available at the time.

Who Is Eligible for a Good Faith Estimate?

You are entitled to receive a Good Faith Estimate if you:

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• Are uninsured, or

• Are insured but choose not to use your insurance benefits for the services provided (i.e., you are paying directly out of pocket)

Please note: Even if you have insurance and plan to submit a Superbill to your insurance company for potential reimbursement, you are still considered a self-pay patient at the time of service—and are therefore entitled to receive a Good Faith Estimate.

How to Request a Good Faith Estimate

You may request a Good Faith Estimate at least one business day prior to your scheduled appointment. We will provide the estimate to you in writing, and it will remain valid for 12 months. You may also request an estimate before you schedule a service.

At our practice, transparency around cost is a priority. That’s why we share an estimated cost with you during your Pre-Evaluation Call—before you commit to starting care—so you can make an informed decision with confidence.

Questions?

If you receive a bill that is at least $400 more than your Good Faith Estimate, you may have the right to dispute the bill.
For more information about your rights under the No Surprises Act, visit www.cms.gov/nosurprises or call 1-800-985-3059.