Good Faith Estimate Notice

For patients who are uninsured or choose not to use insurance.

You have the right to receive a Good Faith Estimate explaining the expected cost of scheduled nonemergency health care.

Your Rights

• If you schedule care 3 to 9 business days in advance, the Good Faith Estimate generally must be provided within 1 business day after scheduling.
• If you schedule care 10 or more business days in advance, the Good Faith Estimate generally must be provided within 3 business days after scheduling.
• You may request a Good Faith Estimate before scheduling care. It generally must be provided within 3 business days after the request.
• The estimate will include the services reasonably expected from Ruhwell Med and their expected charges.
• If a provider or facility bills you at least $400 more than that provider's or facility's Good Faith Estimate, you may be eligible for the federal patient-provider dispute resolution process.

This notice is not itself a Good Faith Estimate for any particular patient or service.

Questions

Ruhwell Med: (979) 205-5460
Federal No Surprises Help Desk: 1-800-985-3059
More information: cms.gov/medical-bill-rights