What is a “Good Faith Estimate”?

A good faith estimate is an estimate provided by a healthcare provider or insurance company that outlines the expected costs associated with a particular medical service or procedure. It includes an itemized list of charges, such as fees for consultations, treatments, and any additional services. The purpose of a good faith estimate is to give patients transparency and insight into the potential costs they may incur before receiving healthcare services. It allows patients to make informed decisions about their healthcare and financial planning.

Your Rights

You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for health care items and services before those services are provided.

If you schedule a healthcare item or service at least 3 business days in advance, ensure that you request a written Good Faith Estimate from your healthcare provider or facility within 1 business day of scheduling. For appointments scheduled at least 10 business days in advance, request the estimate in writing within 3 business days after scheduling. You can also inquire about a Good Faith Estimate before scheduling an item or service, ensuring that you receive it in writing within 3 business days of your request from the healthcare provider or facility.

Please be aware that there may be additional items or services that Dr. Reams might recommend to aid in the success of your treatment and care. These items or services can be scheduled or requested separately and may not be included in this estimate.

Please understand that the information you are receiving on each primary service is only an estimate and may differ from the actual services, items, or charges that may be needed for your individual care/treatment.

Each patient/individual has the right to dispute the billed charges if they are “substantially in excess” of the expected charges included in this estimate. “Substantially in excess” is defined as at least $400.00 more from the charges on this estimate. If you are a self-pay or uninsured individual and you would like to dispute billed charges you may visit www.cms.gov/nosurprises/consumers or call 1-800-985-3059 to report a federal complaint or request more information. You may also call or email our office if you have any questions about your charges. We promise that the quality of your care will not be hindered by any billing dispute.

Please understand that this estimate is not a contract and doesn’t mandate you to receive any service or item listed on this estimate. In our professional opinion, these are only services or items that we believe are necessary for a thorough examination and treatment.

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Good Faith Estimate