Good Faith Estimate

Last updated 02/28/2024

Under the law, as a healthcare provider, I, Natasha Kellenberger, will give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

This estimate is called a “Good Faith Estimate” and explains how much your Therapy services will cost. Here are a few key things you should know about your Good Faith Estimate:

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • You may ensure that I give you a Good Faith Estimate in writing at least 3 business days before your Therapy services or item. You can also ask me for a Good Faith Estimate prior to scheduling.
  • If you receive a bill that is $400 more than your Good Faith Estimate, you can dispute the bill.
  • It’s recommended that you save a copy of your Good Faith Estimate for your records.

For further information, visit cms.gov/nosurprises or call 800-985-3059.