Foothill Family Chiropractic
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Good Faith Estimate

Your Right to a Good Faith Estimate

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

Under federal law, healthcare providers must give patients who do not have insurance, or who are not using insurance, an estimate of the expected charges for scheduled non-emergency items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of non-emergency items or services, including related tests, equipment, and other charges.
  • If you schedule care at least three business days in advance, the estimate generally must be provided within one business day after scheduling.
  • If you schedule care at least ten business days in advance, the estimate generally must be provided within three business days after scheduling.
  • You may also ask for a Good Faith Estimate before scheduling an item or service.
  • If your bill is at least $400 more than the Good Faith Estimate from a provider or facility, you may be able to dispute the bill.
  • Keep a copy or photo of your Good Faith Estimate.

For more information about your rights, visit CMS.gov/NoSurprises.

To request a Good Faith Estimate from our office, call (909) 490-4443.

Foothill Family Chiropractic

La Verne Office

1350 Foothill Blvd
La Verne, CA 91750

(909) 490-4443

Ontario Office

1525 South Grove Ave, Suite 3
Ontario, CA 91761

(909) 504-3060
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