Good Faith Estimate Notice

Under the federal No Surprises Act, health care providers must give patients who are uninsured or who are not using insurance an estimate of the expected charges for medical items and services.

Because Total DC Wellness is a cash-based practice and does not bill general health insurance carriers, this applies to our patients directly.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services, including related costs such as examinations, imaging referrals and follow-up visits.
• You can ask us for a Good Faith Estimate before you schedule, or at any time. If you schedule at least three business days in advance, we will provide a written estimate.
• Make sure to save a copy or picture of your estimate. Our fee schedule is also available on request.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill through the federal patient-provider dispute resolution process. Start with us — we will review the charges with you. You generally must start a dispute within 120 calendar days of the date on your bill.

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

To request an estimate from our office, call 954-433-4773 or email info@totaldcwellness.com.