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Good Faith Estimate Notice

The Good Faith Estimate, a provision under the No Surprises Act (NSA), is designed to provide consumers with predictability of how much they will be charged for the healthcare services they will receive before their appointment. Under the law, healthcare providers must give their patients an estimate of the bill for medical items and services.

Your Rights and Responsibilities

billing graphicYou have the right to receive a comprehensive Good Faith Estimate for non-emergency items or services. This includes all related costs, from medical tests and prescription drugs to equipment and hospital fees.

At Awaken Chiropractic Center, we’ll provide this written estimate at least one business day before your service. You can also ask us, or any provider of your choice, for a Good Faith Estimate prior to scheduling. Remember to keep a record of your estimate.

For medical items or services received on or after January 1, 2022, you can dispute bills $400 higher than your Good Faith Estimate. The dispute must be filed within 120 calendar days after getting the bill.

Protections For You

We are required to:

  • Furnish a Good Faith Estimate before an item or service is scheduled within specific time frames.
  • Provide a list of each item or service grouped by the provider or facility offering care. Each item or service must include certain details, like the health care code assigned to it and the anticipated charge.
  • Clearly explain the Good Faith Estimate over the phone or in person if requested, followed by a written (paper or electronic) confirmation.
  • Ensure the Good Faith Estimate is accessible to you.

For further details on your rights regarding the Good Faith Estimate, please visit www.cms.gov/nosurprises. Contact us today to schedule your next appointment.


Good Faith Estimate Notice | (772) 763-1311