Disclaimer
This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.
The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill. If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill.
You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.
You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.
There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
To learn more and get a form to start the process, go to www.cms.gov/nosurprises/consumers or call 1-800-985-3059.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit
www.cms.gov/nosurprises/consumers or call 1-800-985-3059.
Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.
Patient Right
Estimate of Cost of Services
BCMS Form
BOM 247 GFE Notice 1-10-22
Flourishing Lives will provide all patients who do not have insurance or who are not using insurance an estimate of the bill for therapy services.
Please retain a copy of your “Good Faith Estimate” (GFE) quote.
- Our initial estimate will be for the cost of the first visit, which will be for the evaluation. This estimate will be provided to you at least one (1) business day prior to the evaluation or prior to scheduling, if you prefer.
- Before commencing with a treatment, a second estimate will be provided to you based on the established Plan of Care. If your Plan of Care needs modification during the episode of care because of your therapy needs, a new condition, or per your request, you will be informed and provided with a new estimate, and you will have the option to continue or cease treatments.
- If you receive a bill that is $400 or more than the “Good Faith Estimate,” you can dispute the bill utilizing the Patient-Provider Dispute Resolution Process. The dispute resolution entities (SDR) are certified and selected by Health & Human Services (HHS). You must submit a dispute notice, the provider’s bill, and the “Good Faith Estimate” to HHS within 120 days of receiving the final bill from our practice. HHS will collect a $25 fee with your dispute resolution application.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call Flourishing Lives at (586) 293-1234.
Begin Your Journey To A Flourishing Life
Easy Steps To Start Transforming Your Life Today
Ready to take the first step towards a more fulfilling life? At Flourishing Lives, starting is as simple as reaching out. Our compassionate team is ready to guide you through our straightforward evaluation process, creating a customized plan tailored to you or your loved one’s unique needs. Let’s embark on this transformative journey together
EVALUATION
Work side by side with our team to learn how we can help you and your family thrive using our FL Method that is rooted in a play based approach.
TREATMENT
30-60+ Sessions
Customized Plan
1-3 Sessions Per Week.
Therapeutic breaks from Treatment as Recommended.
Consultative Services/Membership
Become a part of our family to get tips, tricks and help other families through a community and collaboration.