Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

1. Your Right to a Good Faith Estimate

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. Salt & Serum Wellness is a self-pay practice, so this right applies to our patients.

• 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 fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

2. How to Request an Estimate

To request a Good Faith Estimate before you schedule, contact us at Saltserum@gmail.com or (786) 650-7240. We will give you a written estimate of the expected charges for the services discussed.

3. If Your Bill Is Higher Than Your Estimate

If you are billed for at least $400 more than your Good Faith Estimate, you may be able to dispute the charges through the federal patient-provider dispute resolution process. You generally must start the dispute within 120 calendar days of the date on your bill.

4. Questions or More Information

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Contact

Questions about this notice? Contact Salt & Serum LLC at Saltserum@gmail.com or (786) 650-7240. See also our Privacy Policy, Terms of Service, and Medical Disclaimer.