No Surprises Act

Good Faith Estimate

Purpose

This Good Faith Estimate is intended to provide you with an estimate of the charges you'll incur at Early Beginnings Chiropractic. Uninsured and self-pay clients are entitled to Good Faith Estimates as of January 1st, 2022 under the No Surprises Act.

Providers involved in your care

Dr. Camille Berger, DC, NPI - 1275011280

Clinic Fee Structure

Your chiropractic care will include an initial evaluation and a combination of treatments that may include adjustments, progress exams, and scans. If you have any questions about your upcoming appointment, please don't hesitate to reach out before your visit.

The total cost of your care will include the initial visit, plus any follow-up visits, and will be paid as you go. Your first visit will be a comprehensive chiropractic exam, which costs $199, and subsequent office visits are $60 each. During the course of your corrective care plan you will have progress exams, which are $110, and scans, which are $70. The number of visits will vary based on your particular symptoms and goals, which we will discuss during your evaluation.

Clinic Treatment Codes / Units New Patient Exams (99202): $199

Office Visits (98940, 98941, 98942): $60

Scans (99212): $70

Progress Exams (99214): $110

Taping (97039): $30

Estimated Total Cost

New Patient Exams: $199

Subsequent Office Visits (as needed): $60

Scans: $70

Progress Exams: $110

Taping: $30

Disclaimer

This Good Faith Estimate shows the costs of items and services that are reasonably expected based on your health care needs. The estimate is based on information known at the time the estimate was created. It does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.

This Good Faith Estimate is not a contract and does not require you to obtain the services or items from the providers or facility identified in it. You have the right to request another Good Faith Estimate at any time during your course of care.

If the actual billed service charges exceed this estimate by $400 or more, then you (the patient) have the right to dispute the bill via the patient-provider dispute resolution process with the U.S. Department of Health and Human Services (HHS).

Please contact Early Beginnings Chiropractic prior to starting the dispute progress.

If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of 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 this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059