Your Right to Receive a Good Faith Estimate of Expected Charges

This notice explains your right to a Good Faith Estimate of what your care will cost. Because FXN Medical Group never bills insurance, this right applies to every FXN patient.

As a patient who is uninsured or who chooses not to use insurance for your care, you have the right to receive a “Good Faith Estimate” (GFE) of your expected medical costs.

• Under the law, healthcare providers must provide patients who are not using insurance with a written estimate of the total expected cost of any non-emergency items or services.
• If you schedule a service at least 3 business days ahead, we will give you a Good Faith Estimate in writing within 1 business day of scheduling, or within 3 business days if you schedule at least 10 business days ahead. If you ask for an estimate before scheduling, we will give it to you within 3 business days of your request.
• You can also ask our office, and any other provider you choose, for a Good Faith Estimate before you schedule a service.
• Dispute Rights: If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. This dispute must be filed within 120 calendar days of receiving the bill.
• Make sure to save a copy or photo of your Good Faith Estimate for your records.
• You can get your estimate on paper or electronically, such as by email or through our member portal.

For More Information

• For questions about a Good Faith Estimate from our office, please call us at (858) 371-5692.
• For more information about your rights under federal law, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.