Good Faith Estimate
Who is Eligibile for a Good Faith Estimate?
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services at Revitalize Chiropractic. This includes related costs like chiropractic adjustments, therapeutic exercises, diagnostic X-rays, and initial or re-evaluations.
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How it Works
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Before Your Visit: Revitalize Chiropractic will provide you with a written Good Faith Estimate at least 1 business day before your medical service is scheduled (if scheduled at least 3 days in advance), or within 3 business days if scheduled at least 10 days in advance.
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Upon Request: You can also ask our office manager or billing coordinator for a Good Faith Estimate before you schedule an appointment.
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If Billed More: If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill through the federal patient-provider dispute resolution process.
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Insurance and Medicare Expectations
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Commercial Insurance: If we are in-network with your insurance provider (e.g., BCBS, Cigna/ASH, United Healthcare) and you choose to utilize your insurance benefits, your out-of-pocket responsibility will be determined by your plan’s co-pays, co-insurance, and deductibles rather than this baseline estimate.
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Medicare Part B: Medicare rules specify that spinal manipulation for active care is a covered benefit, while exams, X-rays, and maintenance care are non-covered or self-pay. For services not covered by Medicare, an Advance Beneficiary Notice (ABN) will be utilized to outline your exact out-of-pocket costs prior to treatment.
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Keeping a Copy
Make sure to save a copy or picture of your Good Faith Estimate.
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For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call our office directly at (817) 482-3388
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