Good Faith Estimate

Your right to a Good Faith Estimate of expected charges

Neighborhood NP Wellness is a self-pay practice and does not bill insurance. Under the federal No Surprises Act, you have the right to know what your care will cost before you receive it.

Right to Receive a Good Faith Estimate of Expected Charges

Under the law, health care providers need to give patients who don't have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their 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 related costs like medical tests, prescription drugs, equipment, and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• 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 or call 1-800-985-3059.

How to request your estimate

You will receive a written Good Faith Estimate when you schedule a visit, and again before you start a program. You can also ask for one at any time through your patient portal, by calling (971) 203-2317, or by emailing hello@neighborhoodnpwellness.com.

Neighborhood NP Wellness · Cory Killeen, MSN, APRN, FNP-BC · 12420 NW 36th Ave, Vancouver, WA 98685