Your Right to a Good Faith Estimate
If you do not have health insurance, or you have insurance but choose not to use it for your care at Willow & WildFlower Developmental Pediatrics, you have the right to receive an estimate of what your care will cost before you receive it.
This is called a Good Faith Estimate. It is a protection under the No Surprises Act, a federal law that took effect on January 1, 2022.
What the Good Faith Estimate Includes:
A Good Faith Estimate is an itemized list of the expected charges for the care we have discussed with you, including the specific items and services we anticipate providing.
The estimate reflects our best assessment of your care at the time we prepare it. It is not a bill. If your child needs care we did not anticipate, that care will not appear on the estimate.
The Good Faith Estimate can be provided to you on paper or by email, whichever you prefer. Additionally, we are happy to review the estimate with you by phone or in person as well.
When You Will Receive Your Good Faith Estimate:
- If you ask for one: We will provide a Good Faith Estimate in writing within 3 business days of your request. You do not need to use the phrase “Good Faith Estimate” to ask for one, however you will need to advise the staff of what information you require before receive any services. You may request a good faith estimate prior to scheduling any services.
- If you schedule care in advance: We will provide a good faith estimate without you having to ask. The timing depends on how far ahead you schedule.
- Scheduled 0 to 2 business days in advance: An estimate is not required.
- Scheduled 3 to 9 business days in advance: You will receive the estimate within 1 business day.
- Scheduled 10 or more business days in advance: You will receive the estimate within 3 business days.
If your bill is higher than your estimate
If our final bill is at least $400 more than the Good Faith Estimate we gave you, you have the right to dispute it through the federal patient-provider dispute resolution process. An independent third party reviews the bill and determines an appropriate payment.
You must start a dispute within 120 days of receiving your initial bill.
You will need your written estimate to file a dispute, so please keep it somewhere safe. Disputing a bill does not affect your care with us. We will continue to see your child either way.
Questions
If anything about your estimate is unclear, please ask.
Willow & WildFlower Developmental Pediatrics
hello@willowandwildflowerdbp.com
For more information about your rights under the No Surprises Act, visit cms.gov/nosurprises, or call the No Surprises Help Desk at 1-800-985-3059. The Help Desk offers assistance in more than 350 languages.