Good Faith Estimate

You have the right to receive a "Good Faith Estimate" explaining how much your health care will cost.

Under the federal No Surprises Act, health care providers must give patients who don't have health insurance, or who are not using their insurance, an estimate of the expected charges for their care. Longevity Perform is a self-pay practice, so this right applies to you.

• You have the right to receive a Good Faith Estimate of the total expected cost of any non-emergency items or services. You can ask for one before you schedule, or receive one when you schedule.
• If you schedule at least 3 business days in advance, you should receive the estimate in writing within 1 business day after scheduling. If you schedule at least 10 business days in advance, you should receive it within 3 business days after scheduling. If you ask for an estimate before scheduling, you should receive it within 3 business days of your request.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

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.

Request your estimate

Call (939) 308-1870 or email drsierra@longevityperform.com and we will send your Good Faith Estimate in writing.