952-841-2345
 

Call Us Today: 952-841-2345

Call Us Today: 952-841-2345

Imagine your life
with less pain

Visit the
pain management
experts at Twin Cities
Pain Clinic and let us
help you get back the
life you deserve.

Your Right to a Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

In accordance with the No Surprises Act, Twin Cities Pain Clinic will provide an estimate of the bill for medical items and services to any patient who does not have insurance or does not intend to use insurance for their care.

Uninsured and self-pay individuals also have the right to proactively request a good faith estimate before scheduling.

What is included in the good faith estimate?

The good faith estimate will include expected charges for the items or services reasonably expected to be provided together with the primary item or service, including items or services that may be provided by other providers and facilities.

  • For example, for a surgery, the good faith estimate might include the cost of the surgery – both the facility and the physician fee – labs or tests, and any anesthesia used during the operation.

The estimate will consist of an itemized list of each item or service, grouped by each provider or facility offering care. Each item or service will have specific details and the expected charge.

When will I receive my good faith estimate?

Twin Cities Pain Clinic will provide a good faith estimate:

  • Within one business day after scheduling when the primary item or service is scheduled at least three business days in advance or no later than three business days after scheduling when the primary item or service is scheduled at least 10 business days in advance; or
  • Within three business days after an uninsured or self-pay consumer who has not yet scheduled requests a good faith estimate.

Twin Cities Pain Clinic will provide a paper or electronic copy of the good faith estimate based on the patient’s preference, even if the good faith estimate information was provided over the phone or verbally in person.

Additional details

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 (952) 841-2345 and follow prompts for the Billing Department.

RELIEVE YOUR PAIN, RENEW YOUR LIFE!

COVID-19 UPDATE >>
Telemedicine and in-clinic appointments available. Schedule today: 952-841-2345