Good Faith Estimate:
Your Right to Receive a Good Faith Estimate of Expected Charges Under the No Surprises Act:
PhysioWorks, Sports and Wellness, Inc., will provide a “Good Faith Estimate” (“GFE”) of how much our services will likely cost you upon request. If you are paying us directly for your services and you schedule at least 3 days in advance, we will provide a written GFE within 1 day of scheduling. If you schedule at least 10 days in advance, we will provide a written GFE within 3 business days after scheduling.
We will inform you in advance with a new GFE if we plan to increase our fees or we anticipate your costs exceeding your original GFE. If we don’t and we bill you more than $400 in excess of your GFE without informing you in advance, you will have a right to dispute our bill through a federal dispute resolution process. You will need to provide a copy of your GFE to open a dispute, so we recommend that you save and/or print your GFE for future reference.
To request a GFE, please contact us at firstname.lastname@example.org or 256-529-7395
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.