Good Faith Estimate

Under the “No Surprises Act”, you have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. If you are uninsured or insured but self-pay, you have the right to receive this Good Faith Estimate (GFE) for services.

These estimates may change as treatment progresses and are not a guarantee of treatment, length, frequency, or cost. If estimates or services are added or changed, you will receive a new GFE. If the actual costs of services exceed the estimate by $400 or more, you may initiate dispute resolution (DR) by contacting the US Department of Health and Human Services within 120 days at 1-800-985-3059 or www.cms.gov/nosurprises.  Initiating DR will not adversely affect your quality of care. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call Jennifer Warpool, MA, LCAT, ATR-BC at 917.524.6267.