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Under section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are self-paying for a medical service a Good Faith Estimate, or estimate of the cost of your health care services. If you receive a bill of at least $400 more than your Good Faith Estimate, you can dispute the bill. Health care facilities are required to include the following information in your Good Faith Estimate:
Client’s name
Client’s date of birth
Diagnosis codes
Payment method
Provider name
Provider’s National Provider Identifier
Company’s National Provider Id
Tax ID number
Location of services
Estimated cost of services
Client signature and date of signature
List of treatment codes that may be charged
Cost of each treatment code that may be charged
Notice that the client is not obligated or required to obtain any of the listed services from the provider
Revision Health Services provides all self-pay clients with a Good Faith Estimate. These are scanned into each client’s electronic chart and the hard copy is left with each client.