No Surprises Act, 2022
According to the No Surprises Act effective starting January 1st, 2022, a Good Faith Estimate must be supplied to any individual who is uninsured, or who has insurance but chooses not to use it for care provided here at Rejuvenate, llc.
According to bill §149.610(b)(1)(iii)(A-C) (https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-B/part-149), uninsured or self pay patients must be informed of the availability of a good faith estimate of expected charges upon scheduling an item or service. This estimate can be requested from Rejuvenate’s front office by calling 406-677-7722, or by email at email@example.com. The requested good faith estimate will be provided to you within 1-3 business days. This information will also be provided by Rejuvenate staff verbally when scheduling a self pay service, or when questions about the cost of services occur. A good faith estimate provided by Rejuvenate, llc will be within $399 of the actual charges to the patient, as required by the act stated above.
If you have any further questions about this policy or would like to request a Good Faith Estimate for care, you can do so by calling 406-677-7722 or by email to firstname.lastname@example.org.