Your Right to a Good Faith Estimate

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

Under the No Surprises Act, health care providers must give patients who are uninsured, or who are not using insurance, an estimate of the expected charges for medical services.

What this means for you

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services, including physical therapy evaluation and treatment.
• You can ask us for a Good Faith Estimate before you schedule a service, or at any time during treatment.
• If you schedule a service at least three business days in advance, we will provide a Good Faith Estimate in writing within one business day of scheduling. If you schedule at least ten business days in advance, we will provide it within three business days.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you may dispute the bill.
• Keep a copy of your Good Faith Estimate in a safe place.

Our current self-pay rates

So you know what to expect before you ever ask, these are our standard rates for patients not using insurance:

Service	Rate
Initial Evaluation	$135
Follow-Up Treatment Session	$93
In-Home or Mobile Visit — within 15 miles	+ $55
In-Home or Mobile Visit — beyond 15 miles	+ $85

Your written Good Faith Estimate will reflect the specific plan of care recommended for you, including the expected number of visits.

How to request yours

Questions or disputes

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