Your Right to Receive a Good Faith Estimate of Expected Charges
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.
- You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services when you schedule them or when you ask. This includes related costs like tests, equipment, and fees.
- If you schedule at least 3 business days ahead, we will give you a written estimate within 1 business day after scheduling.
- If you schedule at least 10 business days ahead, we will give you a written estimate within 3 business days after scheduling.
- You can also ask us for an estimate before you schedule. If you do, we will give it to you in writing within 3 business days after you ask.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
Questions About This Notice
Sam Mazahreh, DNP, FNP-C, DC
(914) 654-1100
contact@mainchiropracticonline.com
634 Main Street, New Rochelle, NY 10801
More About Your Rights
Visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.
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