Your Rights Under the No Surprises Act

Under federal law, you have the right to know the expected cost of your care before you receive it. This page explains how to request and use a Good Faith Estimate.

Effective Date: January 1, 2022 (federal); page updated May 18, 2026.

DRAFT — please review with legal counsel before finalizing.

Your Right to a Good Faith Estimate

If you are uninsured, or if you are insured but not using your insurance for a particular service, you have the right to receive a Good Faith Estimate (GFE) of the expected charges for non-emergency items and services. This includes related costs like assessments, follow-up sessions, medications, and lab work.

When You'll Receive One

• If you schedule a service at least 3 business days in advance: you'll get a GFE no later than 1 business day after scheduling.
• If you schedule a service at least 10 business days in advance: you'll get a GFE no later than 3 business days after scheduling.
• If you request one before scheduling: you'll get a GFE within 3 business days of your request.

How to Request a Good Faith Estimate

You can request a written GFE for any service before scheduling. Just contact us:

Phone: 385-257-9373
Email: info@hiddengemhealingutah.com

If Your Bill Is Higher Than the Estimate

If you receive a bill that is at least $400 more than your Good Faith Estimate for any provider listed on the GFE, you may dispute the bill through the federal Patient-Provider Dispute Resolution process.

To start a dispute:

• You must initiate the dispute within 120 calendar days of the bill date.
• There is a $25 fee, which is refunded if the dispute is resolved in your favor.
• Visit www.cms.gov/nosurprises or call 1-800-985-3059 for instructions.

Keep Your Estimate

Save a copy of your Good Faith Estimate. You'll need it to support any dispute.

For more information, visit www.cms.gov/nosurprises.