When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

Your right to a Good Faith Estimate

If you don't have insurance or you're paying for care yourself (including Forever Forward's cash-pay visits), you have the right to receive a Good Faith Estimate of your expected charges before your visit.

• Ask for your estimate before you schedule. We'll provide it in writing.
• If your final bill is at least $400 more than the Good Faith Estimate, you can dispute the bill.
• Keep a copy of your Good Faith Estimate.

Questions about your rights

• Contact us: Forever Forward Physical Therapy, Mark Denesha, PT, DPT, 4300 S Congress Ave, Suite 227, Austin, TX 78745, phone 512.788.5258
• Federal No Surprises Helpdesk: 1-800-985-3059
• Learn more: www.cms.gov/nosurprises

This notice is also posted in our clinic.