Legal
Good Faith Estimate
No Surprises Act & Your Right to a Good Faith Estimate
Last updated: September 14, 2026
Draft. This notice has not yet been reviewed by an attorney, and the pricing it refers to is not final. Both will be settled before the practice accepts patients.
Your Rights Under the No Surprises Act
Under the federal No Surprises Act, healthcare providers must give patients who are not using insurance, or who are not planning to use insurance, an estimate of expected charges for items and services before those items or services are provided, upon request or when scheduling care.
What Is a Good Faith Estimate?
A Good Faith Estimate ("GFE") shows the expected costs of items and services that are reasonably expected for your care. It is not a bill, and actual charges may differ somewhat from the estimate if unanticipated services are needed.
You Have the Right to a Good Faith Estimate If:
- You do not have insurance, or
- You are not planning to submit a claim to your insurance for the item or service.
You can ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service, or at any time you request it.
Timing
If you schedule an item or service at least 3 business days in advance, we must provide a Good Faith Estimate no later than 1 business day after scheduling. If you schedule at least 10 business days in advance, we must provide it no later than 3 business days after scheduling. You may also request a Good Faith Estimate before scheduling; we must provide one within 3 business days of your request.
What's Included
[Update this section once services, cash-pay pricing, and insurance participation are finalized.] A Good Faith Estimate will show expected charges for the specific service you are requesting, such as an initial visit, a follow-up visit, or a specific chronic-condition management package, along with an itemized list if multiple services are anticipated.
If Your Bill Is Higher Than Your Estimate
If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill. You must start a dispute within 120 calendar days of the date on the original bill.
For more information about your right to a Good Faith Estimate, or how to file a dispute, visit www.cms.gov/nosurprises or call 1-800-985-3059.
How to Request a Good Faith Estimate
Contact us at (352) 352-8383 or the appointment request form to request a Good Faith Estimate before scheduling, or ask during the scheduling process.