Good Faith Estimate
You have the right to receive a Good Faith Estimate explaining how much your healthcare services are expected to cost.
Under federal law, healthcare providers are required to provide patients who do not have insurance, or who choose not to use their insurance, with an estimate of the expected charges for medical services before those services are provided.
Your Rights
You have the right to receive a Good Faith Estimate for the total expected cost of non-emergency healthcare services provided by Man in Motion, PLLC.
This estimate may include costs associated with physical therapy evaluations, follow-up treatment sessions, wellness membership services, education and coaching, strength and conditioning programs, injury rehabilitation, and other related services that are reasonably expected as part of your individualized care plan.
You will receive a written Good Faith Estimate at least one (1) business day before your scheduled service whenever required by law. You may also request a Good Faith Estimate at any time before scheduling or receiving services.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you may have the right to dispute the charges through the patient-provider dispute resolution process established by federal law.
We encourage you to keep a copy of your Good Faith Estimate for your records.
Important Information
A Good Faith Estimate reflects the costs that are reasonably expected at the time the estimate is issued. Actual services, treatment recommendations, and associated costs may vary based on your individual needs, goals, response to treatment, and clinical findings.
Additional services or treatments may be recommended during the course of your care that were not anticipated when the estimate was created. These services may result in charges that are not included in the original estimate.
A Good Faith Estimate is not a contract and does not require you to receive services from Man in Motion, PLLC or any other provider listed in the estimate.
Your right to receive a Good Faith Estimate and to initiate a dispute regarding certain charges will not affect the quality of care you receive.
Questions or More Information
For more information about your rights under the No Surprises Act, visit www.cms.gov/nosurprises.
If you have any questions or comments regarding this Good Faith Estimate, please contact Man in Motion, PLLC at:
914-306-5791
125 Columbus Ave, Tuckahoe, NY 10707