Your Right to a Good Faith Estimate
Effective Date: 06/22/2026
Your Right to a Good Faith Estimate
Under federal law, the No Surprises Act, you have the right to receive a Good Faith Estimate (GFE) explaining the expected costs of healthcare services before those services are provided.
Healthcare providers and facilities are required to provide patients who are uninsured or who choose not to use their insurance with an estimate of the expected charges for medical items and services.
What This Means at Abundant Life Functional Health, LLC
At Abundant Life Functional Health, LLC, we are committed to transparency and helping our clients understand the expected costs of services before they receive care.
You have the right to receive a Good Faith Estimate outlining the total expected cost of any non-emergency healthcare items or services provided by our practice. This estimate may include charges for consultations, assessments, laboratory testing, wellness programs, health coaching services, supplements, and other services or products recommended as part of your care plan.
Receiving Your Good Faith Estimate
- If your service is scheduled at least 3 business days in advance, you will receive a Good Faith Estimate within 1 business day after scheduling.
- If your service is scheduled at least 10 business days in advance, you will receive a Good Faith Estimate within 3 business days after scheduling.
- You may request a Good Faith Estimate at any time before scheduling a service.
- Good Faith Estimates are typically delivered electronically through a secure method and may also be provided in writing upon request.
If Your Bill Is Higher Than Your Estimate
If you receive a bill that is at least $400 more than your Good Faith Estimate from any provider or facility, you have the right to dispute the bill through the federal patient-provider dispute resolution process.
You may:
- Contact the provider or facility listed on the bill and request that the charges be reviewed.
- Ask for the bill to be adjusted to reflect the Good Faith Estimate.
- Request additional information regarding the charges.
- Ask about available payment arrangements or financial assistance options.
You may also begin a dispute resolution process with the U.S. Department of Health and Human Services.
To use this process, you must initiate the dispute within 120 calendar days of receiving the original bill. A small administrative fee may apply. If the reviewing agency determines that your Good Faith Estimate was accurate, you will only be responsible for the estimated amount. If the agency agrees with the provider, you may be responsible for the higher billed amount.
For more information or to begin a dispute, visit www.cms.gov/nosurprises or call 1-800-985-3059.
Save Your Good Faith Estimate
Please keep a copy of your Good Faith Estimate for your records. You may need it if you are billed more than the estimated amount.
Questions?
If you have questions about your Good Faith Estimate, billing, or your rights under the No Surprises Act, please contact:
Abundant Life Functional Health, LLC
Misty Dawson MSN APRN FNP-BC
Kosciusko County, IN
Phone: 260-291-4266
Email: info@abundantlifefunctionalhealth.com
Website: abundantlifefunctionalhealth.com
For additional information regarding your rights under the No Surprises Act, visit www.cms.gov/nosurprises or call 1-800-985-3059.