No Surprises Act

Your right to a Good Faith Estimate

If you don’t have insurance, or you’re choosing not to use it, you have the right to know what your care will cost before you get it. Here’s exactly how that works with me.

What it is

A Good Faith Estimate, in plain terms

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers must give patients who don’t have insurance, or who aren’t using insurance, an estimate of the expected charges for medical items and services.

  • You have the right to a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like lab tests, supplements, and any equipment or fees.
  • You’ll get your Good Faith Estimate in writing at least one business day before your scheduled service or item. You can also ask for one, from me or any provider, before you schedule.
  • If you get a bill that is at least $400 more than your Good Faith Estimate, you can dispute it.
  • Save a copy or a picture of your Good Faith Estimate.
How I handle it

How it works at Foundry

Foundry Functional Medicine is a membership-based, self-pay practice, so the Good Faith Estimate applies to essentially everyone I see. Current visit and membership pricing is listed on the booking page, and any lab or supplement costs are shown up front.

Before I schedule non-emergency care for you, I’ll provide a written Good Faith Estimate of the expected charges. You can also request one at any time, before you book, and I’ll get it to you. Just reach out.

Request an estimate → Call 317-401-6610
If the bill is higher

Disputing a bill

If you’re billed at least $400 more than your Good Faith Estimate for that provider, you have the right to dispute the bill through the federal patient-provider dispute resolution process. You generally must start the dispute within 120 calendar days of the date on your bill. Keep a copy of your Good Faith Estimate and your bill.

For questions or more information about your right to a Good Faith Estimate, or to start a dispute, visit www.cms.gov/nosurprises or call 1-800-985-3059.

This notice is provided under the federal No Surprises Act. A Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs. The estimate is based on information known at the time it is created and does not include any unknown or unexpected costs that may arise during treatment. It is not a bill, a contract, or a guarantee of your final cost, and it does not require you to obtain the services listed.