Good Faith Estimate - Frantz Cosmetic Center

Good Faith Estimate

Frantz EyeCare and Frantz Cosmetic Center are committed to providing patients who have no insurance coverage or choose not to use their insurance coverage with a Good Faith Estimate. A Good Faith Estimate is an outline of the cost of services and items reasonably expected for your particular health care needs. This estimate is based upon information known at the time the estimate was created, and can be obtained by calling or visiting one of our convenient locations.

The Good Faith Estimate does not include unknown or unexpected costs that could emerge during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the charges you are not in agreement with.

You are free to contact the Frantz EyeCare/Frantz Cosmetic Center offices to let them know that the billed charges are higher than the Good Faith Estimate you were provided with. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

You can initiate a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to move forward with the dispute resolution process, you must start the dispute process within 120 calendar days (approximately 4 months) from the date on the original bill.

There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on the Good Faith Estimate you were provided with. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 800-985-3059.

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059.

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