Good Faith Estimate
Good Faith Estimate & No Surprises Act
Your Rights and Protections Against Surprise Medical Bills
This notice explains your rights under the federal No Surprises Act. It is the federally required “Your Rights and Protections Against Surprise Medical Bills” companion notice for uninsured and self-pay patients who receive a Good Faith Estimate.
Your Right to a Good Faith Estimate
If you do not have health insurance, or if you choose not to use your health insurance, you have the right to receive a Good Faith Estimate of the expected charges for the items and services you are scheduled to receive, before you schedule them.
Your Good Faith Estimate will cover the items and services that are reasonably expected for your care at our practice, based on the information available at the time the estimate is prepared. It is an estimate, not a final bill: the actual charges may differ if additional care is needed or if your care changes.
Other providers or facilities involved in your care may bill separately. For example, if your care involves a laboratory, an imaging facility, an anesthesia provider, or a hospital or surgery center, those providers or facilities may send you their own bills, and their charges may not be included in the estimate we provide.
How to Request an Estimate
To request a Good Faith Estimate from our practice, please call our Okeechobee office at (863) 824-3447 before scheduling your visit or procedure. We will be glad to explain the estimate and answer your questions about the items and services included.
Keep a Copy of Your Estimate
Please keep a copy of your Good Faith Estimate. You may need it to compare with your final bill.
If Your Final Bill Is Higher Than Your Estimate
If the final charges for the items and services in your Good Faith Estimate are at least $400 more than the estimate, you have the right to dispute the bill through the federal patient-provider dispute resolution process.
To start the dispute process, you must file a request within 120 calendar days of the date on your bill. The dispute process is handled through the federal process established under the No Surprises Act. For more information about the dispute process, including how to file a request, please contact our office at (863) 824-3447, or visit the federal No Surprises Act information for consumers.
Protections for Insured Patients
For patients who have health insurance, the No Surprises Act also provides protections against surprise medical bills for emergency care and for certain care provided at an in-network hospital or ambulatory surgical center by an out-of-network provider. In those situations, you generally should not be billed more than your in-network cost-sharing amount for the covered service, and the provider or facility may not balance bill you for the difference. If you believe you have received a surprise bill, please contact us at (863) 824-3447 so we can help you understand it.
Gastro in Florida (AKRO GASTRO LLC)
Dr. Vikram Tarugu, MD
Okeechobee office: 201 SW 16th St, Okeechobee, FL 34974 — (863) 824-3447
Wellington office: 1447 Medical Park Blvd Ste 405, Wellington, FL 33414 — (561) 767-8342