No Surprises Act & Good Faith Estimate

Your Rights Under the No Surprises Act

Under the No Surprises Act, you have the right to receive a Good Faith Estimate explaining how much your medical care is expected to cost if you are uninsured or self-pay (meaning you are not using insurance or are choosing not to bill insurance).

What is a Good Faith Estimate?

A Good Faith Estimate (GFE) is a written estimate of the expected charges for non-emergency healthcare services, including chiropractic care.

You are entitled to receive a Good Faith Estimate if:

  • You do not have health insurance, or

  • You choose not to use your insurance and pay out of pocket

This estimate will be provided:

  • Upon request, or

  • Automatically before scheduled services, as required by law

Billing Disputes

If you receive a bill that is $400 or more higher than your Good Faith Estimate, you have the right to dispute the bill through the U.S. Department of Health and Human Services (HHS).

You may initiate a dispute within 120 days of receiving the bill.

More information about the dispute resolution process can be found at:
www.cms.gov/nosurprises

Questions or Requests

To request a Good Faith Estimate or if you have questions about your rights under the No Surprises Act, please contact:

Refine Chiropractic
Se Yoon Rhee, DC
14591 Newport Ave, Ste 106
Tustin, CA 92780
📞 714-383-3583
✉️ seyoonrheedc@gmail.com