Good Faith Estimate

Last Updated: October 10th, 2025

You have the right to receive a Good Faith Estimate explaining how much your medical care will cost.

 

 

1. Your Rights Under the Law

 

Under the No Surprises Act, healthcare providers are required to give patients who don’t have insurance or aren’t using insurance an estimate of expected charges for medical services.

This estimate helps you understand and plan for the cost of your care before you receive it.

 

 

2. What Is Included in a Good Faith Estimate

 

Your Good Faith Estimate will include:

 

  • The total expected cost of services such as exams, adjustments, x-rays, therapies, or other treatments.

  • Related costs such as supplies or additional wellness services (if applicable).

  • The time period those services and charges cover.

 

This estimate will be provided in writing and is not a bill. The actual cost may vary if your treatment plan changes based on your individual needs or your provider’s recommendations.

 

 

3. When You Will Receive the Estimate

 

 

  • If you schedule a service at least 3 business days in advance, you’ll receive your Good Faith Estimate within 1 business day of scheduling.

  • If you schedule at least 10 business days in advance, you’ll receive it within 3 business days.

  • You may also request an estimate before scheduling any service.

 

 

 

4. If You Receive a Bill Higher Than Expected

 

If you receive a bill that is $400 or more than your Good Faith Estimate, you have the right to dispute the charges.

You can start a dispute process with the U.S. Department of Health and Human Services (HHS) within 120 calendar days of receiving the bill.

To learn more or start a dispute, visit:

https://www.cms.gov/nosurprises

or call 1-800-985-3059.

 

 

5. Contact Us

 

For questions or to request a Good Faith Estimate, please contact:

Energize Chiropractic and Wellness

13325 100th Avenue NE, Suite D

Kirkland, WA 98034

Phone: (425) 814-9644

 

 

6. Reminder

 

This Good Faith Estimate is only an estimate. Actual charges may differ if your care needs change. We are committed to transparency and will discuss any updates to your treatment plan and cost before additional services are provided.

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