Good Faith Estimate Notice

Your Right to Receive a Good Faith Estimate

Under the No Surprises Act, healthcare providers are required to provide uninsured or self-pay patients with a Good Faith Estimate of expected healthcare costs before scheduled services or upon request.

What is a Good Faith Estimate?

A Good Faith Estimate explains the anticipated cost of healthcare items and services that you may receive from Northland Spine and Rehabilitation. The estimate is based on information known at the time it is prepared and is not a contract or guarantee of actual charges.

The estimate may include:

  • Initial examinations
  • Chiropractic treatment
  • Rehabilitation services
  • Therapeutic exercises
  • Physiotherapy modalities
  • Diagnostic imaging (when provided by our office)
  • Other reasonably expected healthcare services

Additional services that are medically necessary but not reasonably anticipated at the time of the estimate may result in additional charges.

Who Can Receive a Good Faith Estimate?

You have the right to receive a Good Faith Estimate if you:

  • Do not have health insurance; or
  • Choose not to use your health insurance for healthcare services.

You may also request a Good Faith Estimate before scheduling services.

Personal Injury, Auto Accident, and Insurance Cases

Northland Spine and Rehabilitation frequently treats patients injured in motor vehicle accidents, work-related injuries, and other personal injury cases.

 

The Good Faith Estimate requirements under the No Surprises Act generally apply to patients who are uninsured or who choose not to use their health insurance to pay for healthcare services.

 

If your treatment is being billed through automobile insurance, Medical Payments (MedPay), Personal Injury Protection (PIP), workers’ compensation, an attorney lien, or another third-party payer, different billing and payment procedures may apply. Because the course of treatment, medical necessity, referrals, diagnostic imaging, and insurance determinations may evolve during your recovery, it is not always possible to accurately estimate the total cost of care in advance.

 

Our team will explain your financial responsibilities, available payment options, and the applicable billing process before treatment begins whenever reasonably possible. If your treatment plan changes significantly, we will discuss any expected financial impact with you as information becomes available.

 

If you have questions about whether you qualify for a Good Faith Estimate or how your care will be billed, please contact our office. We are happy to explain your coverage, billing options, and any anticipated out-of-pocket costs before treatment.

Receiving Your Estimate

If you schedule healthcare services at least three business days in advance, or request an estimate, Northland Spine and Rehabilitation will provide your Good Faith Estimate in accordance with applicable federal law.

Questions About Your Estimate

If your final bill is substantially higher than your Good Faith Estimate, you may have the right to dispute the charges through the federal patient-provider dispute resolution process.

 

For more information about your rights under the No Surprises Act, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Contact Us

If you have questions regarding your estimate or would like to request one, please contact:

Northland Spine and Rehabilitation

8002 N Oak Trafficway, Suite 112

Kansas City, MO 64118

Phone: (816) 569-5079

Email: frontdesk@northlandspine.com

 

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