Good Faith Estimate

1. Your right to an estimate

If you do not have insurance or do not plan to use it to pay for care, you generally have a right to a written Good Faith Estimate of expected charges for scheduled, non-emergency healthcare services. Tell our team that you are uninsured or will be paying without insurance when discussing treatment.

You can request an estimate before deciding whether to schedule. A Good Faith Estimate is not a contract or an obligation to receive treatment.

2. When you receive it

• Care scheduled 3–9 business days ahead: the estimate is due within 1 business day after scheduling.
• Care scheduled at least 10 business days ahead: the estimate is due within 3 business days after scheduling.
• Requested before scheduling: the estimate is due within 3 business days of your request.

The federal advance-estimate requirement generally does not apply to emergency care or appointments scheduled fewer than 3 business days ahead. You can still ask our office about expected charges. See CMS guidance on Good Faith Estimates.

3. What the estimate covers

Your estimate identifies the expected items, services, and charges for your planned care from our practice. Ask us to explain any item you do not understand.

Care from another provider may require a separate estimate. For example, a final crown or other restoration performed by your general dentist, an outside laboratory service, or a pharmacy prescription may be billed separately. Ask each provider about its charges and estimate.

Unexpected clinical findings or complications may change the services needed and actual charges. These possibilities do not remove your applicable billing or dispute rights. If your plan to use insurance changes, tell us so we can discuss how it affects your estimate and billing.

4. If your bill is higher

If a provider’s bill is at least $400 more than that provider’s Good Faith Estimate, you may qualify for the federal patient–provider dispute resolution process. The request must generally be submitted within 120 calendar days of the date on the initial bill.

Keep a copy or photo of your estimate and your bills. You may contact our office to discuss differences and visit CMS’s bill dispute guide for eligibility, required documents, and the process. Contacting our office does not extend the federal filing deadline.

During an active federal dispute, applicable protections include limits on collections and late-fee collection. We will not retaliate against you for exercising your billing rights.

5. Request an estimate or ask a question

Call our team to request your estimate or discuss planned care:

Please use general email only to request a call or ask a general question; do not include sensitive health information.

For information about federal billing protections, visit CMS No Surprises or call the No Surprises Help Desk at 1-800-985-3059.