Good Faith Estimate

As of January 1, 2022, all clients, who are uninsured or opting to self pay for services, and will be beginning a new course of care with us, have the right to a Good Faith Estimate. This is in keeping with the No Surprises Act and will provide a general overview of the costs you are likely to incur throughout your course of care.

You have the right to receive a “Good Faith Estimate” explaining how much your medical 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 medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• 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. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 800-985-3059.

• The “Good Faith Estimate” serves as an estimation of the cost of potential pelvic floor therapy services. This is not an indication of how many pelvic floor therapy visits may be necessary or appropriate. Your total cost of services will depend on the number of pelvic floor therapy sessions you attend. This estimate is not a contract nor does it obligate you to obtain any services from the provider. If you would like to request a Good Faith Estimate before scheduling, please call (774) 314 - 7318 or email info@autonomypelvichealth.com.