Patient Rights
Good Faith Estimate
Right to Receive a Good Faith Estimate of Expected Charges
Under the law, health care providers need to give patients who don't have insurance, or who are not using their insurance, an estimate of the expected charges for medical services, including dental services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
How to Request Your Good Faith Estimate
If you are uninsured, or if you choose not to use your insurance for a visit, you may request a written Good Faith Estimate from our office before scheduling or receiving any non-emergency service. We will provide your estimate in writing at least 1 business day before the scheduled service.
To request a Good Faith Estimate, contact us:
Gentle Care Dental, PLLC
570 Rinehart Road, Lake Mary, FL 32746
Email: hello@gentlecare.dental
Disputing a Bill
If you receive a bill that is $400 or more above the Good Faith Estimate you received, you have the right to dispute that bill. To start the dispute process:
- Contact us first — we may be able to resolve the discrepancy directly.
- If we cannot resolve it, you may submit a dispute through the federal Patient-Provider Dispute Resolution process. Information is available at cms.gov/nosurprises.
- You must initiate a dispute within 120 calendar days of the date on the original bill.
A Good Faith Estimate is not a contract and does not obligate you to obtain the listed services, nor does it guarantee that the listed services will be sufficient to address your dental needs. Actual charges may differ if your circumstances change or if additional services are required.