Good Faith Estimate Notification
Centre Eye Physicians and Surgeons is committed to providing patients who have no insurance coverage or choose not to use their insurance coverage with a Good Faith Estimate. The Good Faith Estimate shows the costs of medical items and services that are reasonably expected for your health care needs. The estimate is based on information known at the time the estimate was created and can be obtained by calling or visiting our office. If you choose to have care performed by Centre Eye Physicians and Surgeons, a written copy of the Good Faith Estimate will be provided to you.
The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.
If you are billed for more than the Good Faith Estimate provided, you have the right to dispute the bill.
You may contact Centre Eye Physicians and Surgeons to let them know the billed charges are higher than the Good Faith Estimate you received. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is a payment plan or financial assistance available.
You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS) if the bill you receive is more than $400 over the amount listed on the Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059.
If you prefer, you can download a copy of this notice as a PDF file.
The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.
If you are billed for more than the Good Faith Estimate provided, you have the right to dispute the bill.
You may contact Centre Eye Physicians and Surgeons to let them know the billed charges are higher than the Good Faith Estimate you received. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is a payment plan or financial assistance available.
You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS) if the bill you receive is more than $400 over the amount listed on the Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059.
If you prefer, you can download a copy of this notice as a PDF file.
