Good Faith Estimate Notice
Queen City Chiropractic & Sports Performance’s Good Faith Estimate is a provision of the No Surprises Act (NSA) designed to provide patients, who choose to self-pay for their treatment, predictability of how much they will be charged for the healthcare services they will receive before their appointment. Under the law, QCC&SP will provide our patients, who request one, an estimate of the bill for medical items and services.
Know Your Rights
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. The estimate should include any associated costs, such as medical tests, prescription drugs, equipment, and hospital fees.
The Good Faith Estimate should be given to you in writing at least one business day before your medical service or item. You can also request that your healthcare provider, and any other provider of your choice, give you a Good Faith Estimate before you schedule an item or service. Make sure you save a copy or picture of your Good Faith Estimate.
For medical items or services received on or after January 1, 2022 you may dispute bills $400 higher than your Good Faith Estimate. The dispute must be filed within 120 calendar days after receiving the bill.
What Providers and Facilities Are Required to Do
- Provide a Good Faith Estimate before an item or service is scheduled, within specific time frames.
- Furnish an itemized 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 to you over the phone or in-person if you request it, and then follow up with a written (paper or electronic) estimate.
- Provide the good faith estimate in a way that’s accessible to you.
For more information about your right to a Good Faith Estimate, please visit www.cms.gov/nosurprises, or call our office at 704-940-3670.