Good Faith Estimate

Patients who are uninsured or who are not using insurance generally have the right to receive a written estimate of expected charges for scheduled, non-emergency healthcare services.

Effective date: July 21, 2026

Your right to an estimate

Ask Elite Chiropractic & Rehab for a Good Faith Estimate before scheduling or receiving an eligible service. When required, the estimate will include reasonably expected charges for the scheduled items or services and will be provided within the timeframe established by federal law.

If the bill is higher

If a billed amount is at least $400 more than the Good Faith Estimate for a provider or facility, you may be eligible to use the federal patient-provider dispute resolution process. Keep a copy or photo of your estimate and bill.

More information

For questions, contact either Elite Chiropractic & Rehab office. Information about federal protections and the dispute process is available at cms.gov/nosurprises or by calling 1-800-985-3059.

This clinic-specific draft should be reviewed by qualified legal counsel and the clinic’s HIPAA privacy officer before production publication.