Your Right to a Good Faith Estimate

Last updated: June 2026

Under the federal No Surprises Act, you have the right to receive a Good Faith Estimate explaining how much your medical care will cost.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like exams, treatment, and any other services Arsenault Family Chiropractic Center provides. If you are uninsured, or you are not planning to submit a claim to insurance for your care, Arsenault Family Chiropractic Center is required to give you a Good Faith Estimate of expected charges before you schedule a service — or any time you ask for one.

What the estimate includes

• The expected charges for the services or items you are scheduling or asking about;
• Related services reasonably expected to be provided together with the primary service;
• A clear, itemized list so you can plan ahead.

How to get one

You can ask Arsenault Family Chiropractic Center for a Good Faith Estimate before you schedule a service, or at any time. Just contact our office at (603) 964-1460. We will provide a written estimate within the timeframe required by law — within 1 business day if your service is scheduled at least 3 business days out, or within 3 business days of your request.

If your bill is higher than your estimate

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill through the federal patient-provider dispute resolution process. You can start a dispute within 120 calendar days of the date on your bill.

Good to know

• A Good Faith Estimate is an estimate of expected charges — it is not a bill, and your actual charges may be lower or higher.
• Receiving a Good Faith Estimate does not obligate you to receive the services.
• Keep a copy of your Good Faith Estimate in a safe place.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.