Good Faith Estimate

Aesthetic Dermatology Associates, PC

Under the law, health care providers are required to provide patients who don’t have health care coverage or who are not using certain types of health care coverage (“Uninsured/Self-Pay Patients”) an estimate of their bill for health care items and services before those items or services are provided.

• If you are an Uninsured or Self-Pay Patient, you have the right to receive a Good Faith Estimate (GFE) for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like prescription drugs, medical tests, equipment, and hospital fees.
• If you schedule a health care item or service at least 72 hours in advance of your appointment, you should receive from your health care provider a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, you should receive a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider for a Good Faith Estimate before scheduling an item or service. Otherwise, you may request that your provider gives you a Good Faith Estimate in writing within 3 business days after you ask. If your bill for the services listed on your GFE is $400 or more for any provider than your GFE for that provider, federal law allows you to dispute the bill.
• Please note, this GFE does not include any unknown or unexpected costs that may arise during your treatment. For example, you may schedule an appointment for a particular reason and during your visit you or the provider may identify other concerns that may lead to costs outside of the GFE. This may include unexpected procedures that were not contemplated at the time this GFE was created (such as a biopsy, which would also result in unanticipated charges for pathology services). You could be charged more if complications or circumstances previously described occur.

For questions or more information about your right to a Good Faith Estimate:
Visit: www.cms.gov/nosurprises/consumers,
Email:  FederalPPDRQuestions@cms.hhs.gov,
Or call: 1-800-985-3059