Good Faith Estimate
Your rights under the No Surprises Act
Your right to a Good Faith Estimate
Under the No Surprises Act, effective January 1, 2022, health care providers and facilities must provide a Good Faith Estimate of expected charges to uninsured clients and to insured clients who choose not to use their insurance for certain scheduled services. CMS guidance requires the estimate to include expected items and services reasonably anticipated for the episode of care.
What the estimate may include
- the anticipated service or evaluation
- expected charges for sessions or related services
- provider or facility identifying information
- standard disclaimers required by federal guidance
How to request an estimate
Call (323) 801-8264 or email office@pasadenaclinicalgroup.com to request a Good Faith Estimate before scheduling or before continuing a course of self-pay services. We may need information about the services you are seeking in order to prepare the estimate as accurately as possible.
If your bill is higher than expected
If you receive a bill that is at least $400 more than your Good Faith Estimate, you may have the right to begin the federal patient-provider dispute resolution process within the timeframe established by federal rules. Keep a copy of your estimate and any related bills for your records.