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Right to Receive a Good Faith Estimate of Expected Charges

Under federal law, patients who are uninsured or who choose not to use insurance have the right to receive a Good Faith Estimate of expected charges for medical services.


What Is a Good Faith Estimate

A Good Faith Estimate explains the expected costs for medical items and services that are reasonably expected for your care at Priority Footwear. This may include office visits, evaluations, fittings, therapeutic shoes, custom orthotics, and any related services or supplies.

The estimate is based on information known at the time it is created. Actual charges may change if your care needs change.


Who Can Receive a Good Faith Estimate

You have the right to receive a Good Faith Estimate if you are uninsured or if you choose to self pay and do not plan to submit a claim to insurance.


When You Will Receive the Estimate

  • If your service is scheduled at least three business days in advance, you will receive a written Good Faith Estimate at least one business day before your appointment
  • If your service is scheduled at least ten business days in advance, you will receive a written Good Faith Estimate at least three business days before your appointment
  • You may also request a Good Faith Estimate at any time before scheduling or receiving services


If Your Bill Is Higher Than the Estimate

If you receive a bill that is at least four hundred dollars higher than your Good Faith Estimate, you may dispute the bill through the federal patient provider dispute resolution process.

This process is administered by the US Department of Health and Human Services.


More Information

For more information about your rights under the No Surprises Act or to begin the dispute resolution process, visit www.cms.gov/nosurprises

You may also call 1-800-985-3059


How to Request a Good Faith Estimate

To request a Good Faith Estimate or if you have questions about pricing, please contact Priority Footwear using the information below before your appointment.

Priority Footwear
10240 SW Nimbus Ave Ste L1
Portland OR 97106
Phone: (866) 557 3478
Email: info@priorityfootwear.com