Your Right to a Good Faith Estimate

Under the federal No Surprises Act, health care providers are required to give patients who do not have insurance, or who choose not to use their insurance, an estimate of the expected cost of their care.

If you are uninsured or self-pay, you have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services at OnSpot Dermatology. This includes related costs such as office visits, procedures, and pathology fees that are part of your visit.

Ask any OnSpot Dermatology billing team member for a Good Faith Estimate before you schedule a service, or request one at any time by calling (941) 444-0011 or emailing [email protected]. If you schedule a service at least three business days in advance, we will provide your estimate in writing at least one business day before your visit. You can also request an estimate before scheduling.

Your Good Faith Estimate is based on the information available at the time it is prepared. Actual charges may differ if your provider recommends additional or different services during your visit.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Learn more at www.cms.gov/nosurprises or call 1-800-985-3059.

Please keep a copy of your Good Faith Estimate for your records.