Your Right to a Good Faith Estimate
If you don't have insurance, or you're not using it, you have the right to know what your care will cost before we begin.
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
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 expected charges for medical items and services.
What You Can Expect
- 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 exams, X-rays, therapies, and equipment.
- You can ask Juarez Chiropractic, and any other provider you choose, for a Good Faith Estimate in writing before you schedule an item or service.
- If you schedule a service at least 3 business days in advance, you'll receive your written estimate at least 1 business day before your visit.
- Make sure to save a copy or a picture of your Good Faith Estimate.
If Your Bill Is Higher Than Your Estimate
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You must start the dispute process within 120 days of the date on your bill.
How to Request Yours
Just ask. Call our office at (773) 823-7005 or speak with us at your visit, and we'll prepare a written Good Faith Estimate for your expected care. We're happy to walk through it with you, in English or Spanish.
More Information
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call (800) 985-3059.
Juarez Chiropractic4614 S Western Ave
Chicago, IL 60609
Phone: (773) 823-7005
This notice is provided to inform you of your rights under the No Surprises Act and is not a bill or a quote for any specific service.