Good Faith Estimate & Non-Discrimination-Statement
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
As a patient, you are entitled to certain civil rights protected by the U.S. Constitution and federal laws, including the Civil Rights Act of 1964 and the Americans with Disabilities Act of 1990. These laws ensure that individuals in the United States have the right to access healthcare and services without facing discrimination. They safeguard your right to be treated fairly and equally when receiving care.
Wake Spine & Rehab complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, or sexual orientation.
This practice:
• Provides information to patients in plain language and in a manner that is accessible and timely.
• Provides free aids and services to people with disabilities to communicate effectively with us, providing written information in accessible formats.
• Provides free language services to people whose primary language is not English, including translated written materials if necessary.
Grievance Procedure
If you believe that Wake Spine & Rehab has failed to provide these services or has discriminated in any way on the basis of race, color, national origin, age, disability, sex, gender identity, or sexual orientation, you can file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
Phone: 1-800-368-1019
TDD: 1-800-537-7697
Online: https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf