Your Right to Receive a Good Faith Estimate of Expected Charges
Under the federal No Surprises Act, you have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost.
Health care providers are required to give patients who don't have insurance, or who are not using insurance to pay for care, an estimate of the bill for medical items and services before those services are provided.
What a Good Faith Estimate covers
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 such as medical tests, prescription drugs, equipment, and facility fees.
When you should receive your estimate
Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your scheduled medical service or item. You can also ask Bensa Chiropractic and Wellness, or any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
Your right to dispute a bill
If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
How to request a Good Faith Estimate from Bensa Chiropractic and Wellness
To request a Good Faith Estimate before scheduling care, contact our office:
- Phone: (941) 405-4088
- Email: info@bensachiropractic.com
- Address: 4618 E State Road 64, Bradenton, FL 34208
For more information
For questions or more information about your right to a Good Faith Estimate, the patient-provider dispute resolution process, or to get a form to start the dispute resolution process, visit www.cms.gov/nosurprises/consumers or call 1-800-985-3059.
This notice is provided in accordance with Section 2799B-6 of the Public Health Service Act and 45 CFR § 149.610.