Your Right to a Good Faith Estimate

Good Faith Estimate Notice

Under the federal No Surprises Act, individuals who do not have certain health coverage or who are not seeking to use their coverage may have the right to receive a Good Faith Estimate of expected charges for scheduled or requested healthcare items and services. See CMS information about Good Faith Estimates.

01

Your Right to a Good Faith Estimate

Under the federal No Surprises Act, individuals who do not have certain health coverage or who are not seeking to use their coverage may have the right to receive a Good Faith Estimate of expected charges for scheduled or requested healthcare items and services.

See CMS information about Good Faith Estimates.

02

What the Estimate Should Include

When required, the estimate should describe reasonably expected charges for the primary item or service and other items or services reasonably expected to be provided as part of the same period of care, within the scope of current federal requirements.

03

If the Bill Is Substantially Higher

Keep the estimate, bill, and related documents. Starting a dispute process does not prevent a patient from asking the provider about the bill or using other available rights.

04

Membership Fees and Separate Services

A membership agreement does not eliminate any Good Faith Estimate duty that otherwise applies.

05

Questions or Requests

Vitruvian Medicine (843) 214-4504 11000 North Scottsdale Rd., Suite 235, Scottsdale, AZ 85254

CMS help and dispute information: CMS Medical Bill Rights