Good Faith Estimate

Under the No Surprises Act, if you do not have health insurance or you are not using insurance, you have the right to receive a Good Faith Estimate explaining how much your medical care will cost. Health care providers must give uninsured and self-pay patients an estimate of the bill for items and services before those items or services are provided.

• You have the right to receive a written Good Faith Estimate for the total expected cost of any non-emergency items or services, including related costs such as medical tests, prescription drugs, equipment, and facility fees.
• Make sure your provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your provider for a Good Faith Estimate before you schedule an item or service.
• If you schedule an item or service at least 3 business days in advance, you should receive the estimate within 1 business day of scheduling. If you schedule at least 10 business days in advance, you should receive it within 3 business days of scheduling.

To request a Good Faith Estimate, call us at (720) 221-8560 or ask any member of our team when you schedule. Be sure to save a copy or picture of your Good Faith Estimate.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You may contact us to let us know the billed charges are higher than the estimate and ask us to update the bill, negotiate the bill, or ask if financial assistance is available. You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start it within 120 calendar days (about 4 months) of the date on the original bill.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059.

Denver Ketamine Clinic, 66 S Logan St, Denver, CO 80209. Phone: (720) 221-8560.

Denver Ketamine Clinic is a trade name of TMS Therapy Centers of Colorado.