Your Right to Receive a Good Faith Estimate

Under federal law, individuals who do not have health insurance or who choose not to use health insurance to pay for their care generally have the right to receive a Good Faith Estimate of the expected charges for scheduled health care services.

What is a Good Faith Estimate?

A Good Faith Estimate provides information about the expected cost of health care items and services that are reasonably anticipated based on the information available at the time the estimate is prepared.

A Good Faith Estimate is not a bill or a contract, and receiving one does not require you to obtain services from Revive Physical Therapy & Training LLC.

When will I receive a Good Faith Estimate?

If you do not have health insurance or are not using health insurance to pay for your care, Revive Physical Therapy & Training LLC will provide a Good Faith Estimate when required by federal law.

You may also request a Good Faith Estimate before scheduling a service.

To request a Good Faith Estimate, contact:

Revive Physical Therapy & Training LLC
3912 Slate Drive
Champaign, IL 61822
Phone: (785) 341-5185
Email: info@revivephysicaltherapyandtraining.com

What if my bill is higher than my estimate?

If the final billed charges from a provider or facility are at least $400 more than the expected charges listed for that provider or facility on your Good Faith Estimate, you may be eligible to use the federal Patient-Provider Dispute Resolution process.

Using the dispute-resolution process will not adversely affect the quality of care you receive.

For additional information about Good Faith Estimates and your rights under federal law, visit the Centers for Medicare & Medicaid Services (CMS) Medical Bill Rights website or call the federal No Surprises Help Desk at 1-800-985-3059.

Please keep a copy of any Good Faith Estimate you receive so that you can compare it with future bills.