While the majority of bankruptcies are due to emergency medical care, air ambulance services, or surprise fees from hospitals, this law cumbersomely applies to all practitioners including clinics such as ours. This estimate is intended to provide you with the likely charges you may incur here. This page describes your protection against unexpected bills.
Disclaimer: This Good Faith Estimate shows the costs of items and services that are reasonably expected based on your health care needs. The estimate is based on information known at the time the estimate was created. It does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.
This Good Faith Estimate is not a contract and does not require you to obtain the services from the providers or facility identified in it. You have the right to request another Good Faith Estimate at any time during your course of care. If the actual billed service charges exceed this estimate by $400 or more, then you (the patient) have the right to dispute the bill via the patient-provider dispute resolution process with the U.S. Department of Health and Human Services (HHS). Please feel free to contact us first so that we may address any glaring discrepancy. If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059
The Good Faith Estimate provided by this office is based on the most common conditions seen within our office (back pain, neck pain, sciatica, radiculopathy, extremity pain, headache, jaw pain, vertigo) and the services we most typically provide to treat those conditions.
Initial Visit (defined as all patients NOT seen in the previous 3 years) Your initial visit will include an exam (99202-99205) and, if needed, will include x-ray images (71045-73660).
Your subsequent visits will likely include a combination of chiropractic manipulative therapy (98940-98942) and/or therapeutic exericse (97110) and/or manual therapy (97140).
Reevaluations will include an exam (99212-99215) and will likely include chiropractic manipulative therapy (98940-98942) and/or therapeutic exercise (97110) and/or manual therapy (97140).
If other services are provided, you will retain your protections to dispute your charges in the almost entirely impossible chance that your billing for any of the above described individual visits was off by greater than $400, although we cannot envision a scenario where that would be mathematically possible.
Despite the best intentions of the No Surprises Act, it is impossible for a clinic to fully gauge which services will be provided to a patient who has yet to be evaluated.
All clients who complete an initial evaluation will receive a quote of serivces for their records. This is their official Good Faith Estimate.