No Surprises Act and Good Faith Estimates:
Important Information for Patients & Families

Dear Patients and Families-

As of January 1, 2022, under Section 2799B-6 of the Public Health Service Act, new procedures have been enacted that require all health care providers and health care facilitates to inform self-pay individuals of their right to a “Good Faith Estimate” (GFE) to help you estimate the expected charges you may be billed for receiving specific health care 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 related costs such as; medical tests, individual, couples, family, and group therapy, psychiatric care, case consultation fees, and case management.

• Make sure your health care provider gives you a GFE in writing at least one business day before your service or item. You can also ask your healthcare provider, and any other provider you choose, for a GFE before you schedule an item or service.

• If you receive a bill that is at least $400 more than your GFE you have the right to dispute the bill.

• We ask that you make sure to save a copy or picture of your GFE for your records.

• Dr. McGlew will retain copies of each of your GFE’s as well as any updated GFE’s throughout your care with Dr. McGlew. Copies of your GFE’s will be made immediately available to you upon your request up to six years after the date on the estimate. They will also be uploaded to your Patient Portal for your easy access.

For Questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call (800)-368-1019.