Right to a Good Faith Estimate of Expected Charges

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

Under the law, health care providers must give patients who do not have insurance, or who are not using insurance, an estimate of the expected charges for medical items and 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 such as medical tests, prescription drugs, equipment, and hospital fees furnished by the providers that bill for them. OriginalMD is a cash-pay practice; it does not bill health insurance, Medicare, Medicaid, or any other third-party payor.

Make sure your health care provider gives you a Good Faith Estimate in writing at least one 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.

Under Colorado law (C.R.S. § 25-49-106), you also have the right to a self-pay estimate upon request, and the final cost of the services may not exceed the estimate by more than the lesser of 15% or $400, except for emergency or unforeseen medically necessary services.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059. To request a Good Faith Estimate from OriginalMD, call (720) 575-0267 or email info@originalmd.com. This notice is available in Spanish upon request. Esta notificación está disponible en español a solicitud.