Good Faith Estimate Notice
Under the federal No Surprises Act, health care providers generally must provide uninsured and self-pay individuals with an estimate of the expected charges for scheduled or requested items and services.
When you may receive an estimate
- When services are scheduled at least three business days in advance.
- When you request an estimate before scheduling.
- When you tell us that you do not have insurance or do not plan to submit the services to insurance.
What the estimate includes
The estimate will identify the reasonably expected charges for the primary service and other items or services reasonably expected to be provided as part of the scheduled care. Actual services and charges may differ when your needs, schedule, treatment recommendations, or service duration change.
Keep your estimate
Save a copy or photograph of your Good Faith Estimate. You may need it if you receive a bill that is substantially higher than expected.
Disputing a bill
If a bill from a provider is at least $400 more than that provider’s Good Faith Estimate, you may be eligible to use the federal patient-provider dispute resolution process. Using that process does not affect your right to ask Little Oaks about the bill first.
Questions
Contact Little Oaks at jennifer@littleoaksbehavioral.com or (704) 998-1151 to request an estimate or ask about expected charges.
For additional federal information about Good Faith Estimates and patient rights, visit the Centers for Medicare & Medicaid Services website.