Good Faith Estimate
Information for uninsured and self-pay patients
Embers of Peace & Wellness LLC is currently a private-pay practice. If you do not have insurance or choose not to use insurance for a service, federal law generally requires healthcare providers to provide a Good Faith Estimate (GFE) of expected charges when you schedule eligible services sufficiently in advance or request an estimate.
What Is a Good Faith Estimate?
A Good Faith Estimate is an itemized estimate of expected charges for healthcare items and services that are reasonably expected to be provided. It is an estimate, not a bill, and actual care may differ if your clinical needs or requested services change.
How to Request an Estimate
You may request a Good Faith Estimate before scheduling care by contacting the practice:
Phone: 943-300-5764
Email: lrimentalnp@emberspw.net
Please do not include sensitive medical information in an ordinary email request.
When You Can Expect the Estimate
- If you request a Good Faith Estimate before scheduling, it generally must be provided within 3 business days of the request.
- If you schedule a service 3–9 business days in advance, the estimate generally must be provided no later than 1 business day after scheduling.
- If you schedule a service 10 or more business days in advance, the estimate generally must be provided no later than 3 business days after scheduling.
These requirements and timeframes are subject to applicable federal rules and any applicable state requirements.
If Your Final Bill Is Substantially Higher
Under the federal No Surprises Act, an eligible uninsured or self-pay patient may have a right to dispute a bill when the billed amount from a provider is at least $400 more than the provider’s Good Faith Estimate, subject to the requirements of the dispute process.
For current federal information, visit CMS: Medical Bill Rights When Not Using Insurance.
Important
A Good Faith Estimate does not replace informed consent, a financial policy, a treatment plan, or clinical decision-making. It also does not guarantee that a specific service will be clinically appropriate or provided.