Good Faith Estimate

Notice of Your Right to a Good Faith Estimate

Ami Swanson Wellness PLLC
You have the right to receive a Good Faith Estimate explaining how much your health care is expected to cost.
If you are uninsured or are eligible as a self-pay patient under federal law, you can request a written estimate of expected charges before receiving non-emergency care. The estimate includes expected charges for services provided by the Practice. Ask other providers, such as laboratories or pharmacies, for estimates of their separate charges.

If you schedule care 3–9 business days in advance, we will provide an estimate within 1 business day after scheduling. If you schedule at least 10 business days in advance, we will provide it within 3 business days after scheduling. You can also request an estimate before scheduling; we will provide it within 3 business days after your request.

If a provider or facility bills you at least $400 more than its estimate, you may be eligible to dispute the bill through the federal patient-provider dispute resolution process. Keep your estimate so you can compare it with your bill.

To request an estimate from Ami Swanson Wellness PLLC, call 712-339-5467 or contact us through the Practice Better portal. Our office is at 1212 18th St., Suite B, Spirit Lake, IA 51360.

For more information about federal estimate rights and dispute resolution, visit www.cms.gov/nosurprises or call 1-800-985-3059.
These federal GFE and dispute procedures do not apply to patients enrolled in Medicare, Medicare Advantage, Medicaid, or other federal health care programs. We provide those patients with applicable fee information separately.