Good Faith Estimate

Your right to a Good Faith Estimate

Under the federal No Surprises Act, health care providers must give patients who do not have insurance, or who are not using insurance, an estimate of the expected charges for their care. This is called a Good Faith Estimate. This page explains that right and describes the services most often provided by Wellness Lab 41000 LLC, doing business as Greenlight Chiropractic & Wellness Lab.

You can ask for a Good Faith Estimate before you schedule care, and you are entitled to one when you schedule care at least 3 business days in advance. You are entitled to seek care from an in-network provider and may contact your insurer to find one. You are not required to sign this notice.

Contact your insurer to verify whether we are in network with your plan. If you are insured with one of our contracted plans, the information below applies only if you are ever without that coverage.

If you are uninsured or are being seen out of network (self-pay), ask your office about enrolling, at no cost, in the discount medical plan organization we contract with. This is how we are able to offer a discounted fee schedule while staying compliant with our insurance contracts and with federal and state billing laws.

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 services 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 charges exceed this estimate by $400 or more, you have the right to dispute the bill through the patient-provider dispute resolution process with the U.S. Department of Health and Human Services (HHS). Please contact us first so we can review the bill with you. If you choose to use the dispute resolution process, you must start it 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 pay the price on this Good Faith Estimate. If the agency agrees with the health care provider or facility, you will 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.

Initial Visit (defined as all patients NOT seen in the previous 3 years) Your initial visit will include an exam (99202-99205) and will likely include chiropractic manipulative therapy (98940-98942) and/or therapeutic exercise (97110) and/or manual therapy (97140).

Your subsequent visits will likely include a combination of chiropractic manipulative therapy (98940-98942) and/or therapeutic exercise (97110) and/or manual therapy (97140).

Reevaluations will include an exam (99212-99215) and will likely include chiropractic manipulative therapy (98940-98942) and/or therapeutic exercise (97110) and/or manual therapy (97140).

A clinic cannot know in advance exactly which services a patient will need before that patient has been examined.

The above Good Faith Estimate is based on the most common conditions seen within our office (back pain, neck pain, sciatica, radiculopathy, extremity pain, headache, jaw pain, vertigo) and the services we most typically provide to treat those conditions.

If other services are provided, you keep your right to dispute charges that exceed your estimate by $400 or more. The total cost of your care cannot be estimated in advance, because it includes the initial visit plus any later visits and re-evaluations, which are paid as you go.

The number of visits will vary based on your symptoms, goals, and response to care. All care is a trial of care, meaning that we cannot warrant outcomes, and your response to care will guide whether care continues, stops, or is referred elsewhere.

Wellness Lab 41000 LLC, doing business as Greenlight Chiropractic & Wellness Lab
Mailing address: PO Box 3265, Rancho Santa Fe, CA 92067
Phone: Lake Forest (949) 586-2731, San Diego (858) 485-8220, Spring Valley (619) 465-9700