Appointment
No Surprise Billing Act

You have the right to receive a “Good Faith Estimate” explaining how much your healthcare will cost.

Under the law, you have the right to receive an estimate explaining how much your medical care with us will cost.  This means that we—as well as other healthcare providers or facilities involved in your care—must give patients who do not have certain types of healthcare coverage or who are not using certain types of healthcare coverage this estimate before you receive the healthcare items or services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

 

  • If you schedule a healthcare item or service at least 3 business days in advance, we will provide you with a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a healthcare item or service at least 10 business days in advance, we will provide you with a Good Faith Estimate in writing within 3 business days after scheduling.

 

  • You may also ask us for a Good Faith Estimate before you schedule a healthcare item or service, and we will provide the Good Faith Estimate to you within 3 business days after you ask.

 

  • 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 and the bill.

 

For questions or more information about your Good Faith Estimate, you can contact us at

Dallas: 972-733-6565 or info@gtw-health.com

Fort Worth: 817-524-1811 or fortworth@gtw-health.com

McKinney: 972-502-9099 or mckinney@gtw-health.com

 

For questions or more information about your right to a Good Faith Estimate, visit

http://www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.

 

©2022 Girls to Women/Young Men's Health & Wellness
Dallas : 972-733-6565
Fort Worth : 817-524-1811 McKinney : 972-502-9099

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