You have the right to receive a Good Faith Estimate explaining how much your medical care will cost. Under the law, healthcare providers need to give patients who do not have health insurance or are choosing not to utilize their medical insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes fees for office visits and medical tests.
• The Good Faith Estimate will be provided to you one (1) business day before your medical service. In the event the care is emergent or additional testing is recommended during the visit, you will receive a Good Faith Estimate at the time these services are rendered.
• A Good Faith Estimate can be requested before scheduling a service. The Good Faith Estimate will be based on the information available at the time the service is scheduled. Please be advised that exact care cannot be determined until you are evaluated by the physician and additional services may be recommended or required.
• If you receive a bill that is at least $400 more than the Good Faith Estimate provided for the care you received, you may dispute the bill under the new patient-provider dispute resolution process.
• Make sure to save a copy or picture of the Good Faith Estimate you received.

For questions and additional information about your rights under the No Surprises Act, please visit www.cms.gov/nosurprises.

Disclaimer: The information provided is a Good Faith Estimate only. It is based on information known at this time about the planned services, is not binding, is not a guarantee of final billed charges, is valid only for services provided by Cardinal Family Eye Care, LLC and its providers, and is valid for 30 days from the date provided. Final billed charges may vary from good faith estimates for many reasons including, but not limited to: the patient’s medical condition; unknown circumstances, complications, or findings; final diagnosis, and recommended treatment, devices, supplies, and/ or services ordered by a practitioner.