Good Faith Estimate

The No Surprises Act, which took effect January 1, 2022, gives uninsured clients, and insured clients who choose not to use their insurance, the right to receive a written Good Faith Estimate of expected costs before services begin. At Lifespan, we provide this estimate in writing before your first scheduled appointment. The Good Faith Estimate is not a bill and not a guarantee of final charges, but it lays out the expected cost of services in a clear, itemized format so that there are no surprises. It covers the specific services anticipated, the estimated cost of each service, the provider's name and credentials, and the expected dates of service. If you have questions about your estimate at any time, contact us at info@lifespanfps.com or (805) 852-5039.

What we provide

• A written Good Faith Estimate delivered before or at your first appointment
• Itemized expected charges by service type, with CPT codes where applicable
• Your clinician's name, credentials, and tax identification information as required by federal law
• A clear explanation of how to request an updated estimate if the scope of services changes
• A copy retained in your clinical file for your records

Disputing a bill

If you receive a bill that is at least $400 more than the Good Faith Estimate you were provided, you have the right to dispute that charge under federal law. To initiate a dispute, contact the federal No Surprises Help Desk at 1-800-985-3059 (available Monday through Friday, 8 am to 8 pm ET). You can also find dispute forms and additional guidance at <a href="https://www.patientadvocate.org" target="_blank" rel="noopener">patientadvocate.org</a>. Disputes must be filed within 120 days of the date of the original bill. Lifespan is committed to resolving billing concerns promptly and directly, if you believe an invoice does not reflect what was discussed, contact our office first and we will address it.