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Practice information

Your right to a Good Faith Estimate

Uninsured and self-pay patients have a federal right to a written Good Faith Estimate of expected charges before scheduled care. Here is how to request one.

PFC

Under the federal No Surprises Act, patients who are uninsured or who choose not to use insurance have the right to a written estimate of expected charges before scheduled care. This is called a Good Faith Estimate.

What the estimate includes

  • The expected services for your visit or course of care.
  • The expected charge for each service.
  • The total expected cost, in writing, before care begins.

How to request one here

  1. Call the office at (517) 750-7790 when you schedule, and say you are self-pay or not using insurance.
  2. Ask for a Good Faith Estimate. Staff will prepare it based on the planned services.
  3. Review it before your visit. If the plan changes after your examination, ask for an updated estimate.

If the bill is much higher than the estimate

If you are billed at least $400 more than your Good Faith Estimate, you may dispute the bill through a federal process. Details and forms are available from the CMS No Surprises help center or by phone at 1-800-985-3059.

Keep a copy of your estimate. You can also request one in writing at 833 Laurence Ave., Suite B, Jackson, MI 49202.