Good Faith Estimate Notice

You have the right to receive a Good Faith Estimate of charges.

Under federal law, healthcare providers must give patients who don't have insurance, or who are not using insurance to pay for their care, an estimate of expected charges before treatment begins. Because Flora Pediatric Therapy is a private-pay practice, every family who schedules services with us is entitled to this estimate.

What you can expect:

- When you schedule an evaluation or treatment, we will provide you with a written Good Faith Estimate of the expected costs for your child's care.

- You can also request an estimate at any time before scheduling, simply by asking.

- This estimate will include the cost of services we expect to provide, based on the information available to us at that time.

Your right to dispute a bill

If your final bill is substantially higher than your Good Faith Estimate (generally, $400 or more above the estimated amount for the same provider), you have the right to dispute the charge. You must start this process within120 days of receiving the bill in question. Disputing a bill will never affect the quality of care your child receives from us.

For more information about your rights under the No Surprises Act, or to learn how to start a dispute, visit [www.cms.gov/nosurprises](https://www.cms.gov/nosurprises) or call 1-800-985-3059.

A Good Faith Estimate is not a contract. It does not obligate you to receive services from Flora Pediatric Therapy, and it is not a guarantee of your final bill — unexpected needs that arise during care may result in additional charges.

*Questions about your estimate or about billing? Contact us at [412-203-5194/amyz@florapediatrictherapy.com and we're happy to walk through it with you.