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Good Faith Estimate (GFE) Notice
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Your Right to a Good Faith Estimate
Effective Date: September 8, 2026
At New Life Wellness, we believe in transparent pricing to ensure our patients understand their rights when it comes to medical costs.
The No Surprises Act was designed to protect you from unexpected medical bills, and part of this law includes your right to a Good Faith Estimate (GFE) for your healthcare services.
If you don’t have health insurance, you choose not to use your insurance to pay for your care, or your insurance does not cover your treatments, you have the right to receive a Good Faith Estimate (GFE) in writing that explains how much your care is expected to cost.
This applies to services including self-pay ketamine (IV/IM) infusions, vitamin/nutrient IV therapy, psychotherapy, and any Spravato™, TMS (EXOMIND), or other wellness services you choose to pay for out of pocket and/or are unable to bill insurance for.
What is the No Surprises Act?
The No Surprises Act, effective January 1, 2022, is a federal law that protects patients from receiving surprise medical bills for out-of-network services, emergency care, and certain other medical expenses. This law ensures that you are not charged more than the in-network cost-sharing amount for covered services when you unknowingly receive care from an out-of-network provider at an in-network facility.
What a Good Faith Estimate Includes
Your estimate will show the expected costs of:
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The recommended treatment or service
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Any related items or services likely to be part of your care (for example, monitoring, prep/integration sessions, or follow-up visits)
This is an estimate only. Your actual costs may be different depending on what happens during your treatment.
When You’ll Receive It
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If you schedule at least 10 days in advance, we will deliver a good faith estimate to you within 3 days of scheduling. If you schedule at least 3 days in advance, we will deliver a good faith estimate to you within 1 day of scheduling. If you schedule less than 3 days in advance, you may not receive a good faith estimate prior to your appointment.
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You may also request an estimate at any time. We will return a good faith estimate within 3 days of your request.
- Make sure to save a copy or picture of your estimate and the bill.
How to Request Your Estimate
Call our office or ask your care coordinator during your consultation. We’re happy to walk through pricing for ketamine, Spravato, TMS, or wellness packages before you commit to a treatment plan.
Phone: (937) 717-3575
Email: info@newlifewellnessclinic.com
What to Do If You’re Billed More Than Your Estimate
- If you receive a bill that is at least $400 more than your estimate, you can dispute the bill by visiting cms.gov/nosurprises/consumers.
- For questions or more information about your right to a Good Faith Estimate, visit
- For questions or more information about your right to a good faith estimate, please visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1- 800-985-3059.