No Surprises Act
Good Faith Estimate
If you don’t have health insurance or you don't plan on using your insurance to cover the healthcare expenses, generally, health care providers and facilities must give you an estimate of expected charges when you schedule an appointment for a health care item or service, or if you ask for an estimate. This is called a “good faith estimate.”
At WALTZ Trauma Care and Therapy, you will be given a Good Faith Estimate prior to the onset of any services. With your agreement in writing, we will move forward with the first appointment. If you are an ongoing long-term client, or service recipient, you may be given a range of service dates outlining an estimated cost of services.
A good faith estimate isn’t a bill
The good faith estimate shows the list of expected charges for items or services from your provider or facility. Because the good faith estimate is based on information known at the time your provider or facility creates the estimate, it won’t include any unknown or unexpected costs that may be added during your treatment. Generally, the good faith estimate must include expected charges for:
The primary item or service
Any other items or services you’re reasonably expected to get as part of the primary item or service for that period of care.
Your right to a good faith estimate
Providers and facilities must give you the good faith estimate:
After you schedule a health care item or service. If you schedule an item or service at least 3
business days before the date you’ll get the item or service, the provider must give you a good faith estimate no later than 1 business day after scheduling. If you schedule the item or service OR ask for cost information about it at least 10 business days before the date you get the item or service, the provider or facility must give you a good faith estimate no later than 3 business days after you schedule or ask for the estimate.
That includes a list of each item or service (with the provider or facility), and specific details, like the health care service code.
In a way that’s accessible to you, like in large print, Braille, audio files, or other forms of
Providers and facilities must also explain the good faith estimate to you over the phone or in person if you ask, then follow up with a written (paper or electronic) estimate, per your preferred form of communication.
Keep the estimate in a safe place so you can compare it to any bills you get later. After you get a bill for the items or services, if the billed amount is $400 or more above the good faith estimate, you may be eligible to dispute the bill at https://www.cms.gov/nosurprises/consumers/medical-bill-disagreements-if-you-are-uninsured.