Good Faith Estimate

Your Right Under the No Surprises Act

Under Section 2799B-6 of the Public Health Service Act, healthcare providers and healthcare facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal healthcare program, or who are not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling healthcare items and services, to receive a Good Faith Estimate of expected charges.

What Is a Good Faith Estimate?

A Good Faith Estimate is an estimate of the total expected cost of any non-emergency healthcare items or services, including related costs like medical tests, prescription drugs, equipment, and facility fees. The estimate is provided before you receive the service so you can plan ahead.

Who Is Eligible?

You have the right to receive a Good Faith Estimate for the total expected cost of any healthcare item or service if:

• You do not have insurance
• You are not using insurance to pay for the service
• You are choosing to self-pay for the service

How to Request an Estimate

You can request a Good Faith Estimate before you schedule a service, or at any time during the scheduling process. To request an estimate from Meridian Integrative Wellness, please contact our office:

If you schedule a healthcare item or service at least 3 business days in advance, we will provide you with a Good Faith Estimate within 1 business day after scheduling. If you schedule a service at least 10 business days in advance, we will provide the estimate within 3 business days after scheduling.

Important Information About Estimates

• The Good Faith Estimate is not a bill and does not require payment
• The actual cost of services may differ from the estimate if your care needs change during treatment
• The estimate does not include unexpected costs that may arise during treatment
• You will be informed of any changes to your expected charges

Dispute Resolution

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You may contact the healthcare provider or facility to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days of the date on the original bill.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Contact Us

For questions about Good Faith Estimates or to request an estimate: