Patient Rights:
Estimate of Cost of Services + Good Faith Estimate Notice

You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost. Under the law, health care providers need to give patients who do not have insurance or who are not using insurance (self-pay) an estimate of the bill for medical items and services.  The estimate is based on information known at the time the estimate was created. The Good Faith Estimate costs are estimates and not the final overall total charges.The Good Faith Estimate is not a contract and does not require you (uninsured or self-pay) to obtain the items and services from any of the providers or facilities identified on the Good Faith Estimate. From the Ground Up Physical Therapy & Wellness will provide all patients an estimate of the bill for therapy services. Please retain a copy of your "Good Faith Estimate" (GFE) quote.

  • If you schedule an item or service at least 3 business days before the date you’ll get the item or service, the provider must give you a good faith estimate no later than 1 business day after scheduling. If you schedule the item or service OR ask for cost information about it at least 10 business days before the date you get the item or service, the provider or facility must give you a good faith estimate no later than 3 business days after you schedule or ask for the estimate

  • Our initial estimate will be for the cost of the first visit, which will be for the evaluation. This estimate will be provided for you as stated above or prior to scheduling, if you prefer. 

  • Before commencing with a treatment, a second estimate will be provided to you based on the established Plan of Care. If your Plan of Care needs modification during the episode of care because of your therapy needs, a new condition, or per your request, you will be informed and provided with a new estimate, and you will have the option to continue or cease treatments.

  • If you receive a bill that is $400 or more than the "Good Faith Estimate", you can dispute the bill utilizing the Patient-Provider Dispute Resolution Process. You must submit a dispute notice, the provider's bill, and the "Good Faith Estimate" to HHS within 120 days of receiving the final bill from our practice. HHS will collect a $25 fee with your dispute resolution application. 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 healthcare provider you will have to pay the higher amount. You may contact the healthcare provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate or ask to negotiate the bill, or ask if there is financial assistance available. The initiation of the patient-provider dispute resolution process will not adversely affect the quality of health care services furnished to an uninsured (or self-pay) individual by a provider or facility.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises, call 1-800-985-3059, or call From the Ground Up Physical Therapy & Wellness at 816-323-0992.