No Surprises Act
No Surprises Act Policy
Vibrant Health Chiropractic
Effective Date: [01/01/2025]
At Vibrant Health Chiropractic, we are committed to transparency in healthcare costs and ensuring our patients understand their financial responsibilities. In compliance with the No Surprises Act, effective January 1, 2022, we provide the following information regarding your rights and protections from unexpected medical bills.
Your Rights Under the No Surprises Act
The No Surprises Act is a federal law designed to protect patients from unexpected medical bills when receiving healthcare services. Under this law, you have the right to:
-
Receive a Good Faith Estimate: If you are uninsured or not using insurance, you have the right to receive an estimate of the expected charges for your healthcare services before your appointment.
-
Avoid Surprise Bills: You will not receive a surprise medical bill from Vibrant Health Chiropractic for services that were not disclosed to you in advance.
-
Dispute a Bill: If the final billed amount is at least $400 more than your Good Faith Estimate, you have the right to dispute the charge.
Good Faith Estimate (GFE)
-
If you are a self-pay patient (not using insurance) or uninsured, you are entitled to a Good Faith Estimate outlining the expected costs of services. This estimate will be provided:
-
Upon request before scheduling an appointment
-
When you schedule a service (at least 3 days in advance for scheduled visits)
-
In writing, via email or paper copy, if requested
-
The Good Faith Estimate will include:
-
The estimated cost of services
-
Any associated fees for treatment
-
The validity period of the estimate
Billing & Payment Policies
• You will not be charged more than the agreed-upon rate unless additional services are requested or required during treatment.
• Any additional services beyond the Good Faith Estimate will be discussed with you before proceeding.
• Payment is due at the time of service unless other arrangements are made.
How to Dispute a Bill
If you receive a bill that is at least $400 more than your Good Faith Estimate, you may:
1. Contact us directly at [Insert Phone Number] or [Insert Email] to discuss the discrepancy.
2. File a dispute with the U.S. Department of Health & Human Services (HHS) within 120 days of receiving the bill. Visit www.cms.gov/nosurprises or call 1-800-985-3059 for more information.