Your Right to a Good Faith Estimate (GFE)
If you are uninsured, self-pay, or choose not to use insurance for a service at Samara Therapy Specialists, you have the right to receive a written Good Faith Estimate (GFE) explaining the expected cost of items and services we reasonably anticipate providing. You can ask for a Good Faith Estimate before you schedule a service, or you’ll receive one when you schedule.
Your GFE will include the expected charges for services from Samara Therapy Specialists’ providers. It is not a contract, and the actual items, services, or charges may vary. Some services that are scheduled separately or provided by other professionals may not be included in your estimate; you can request separate estimates for those if needed.
If you receive a bill that is $400 or more above your estimate, you have the right to dispute the charges through the federal Patient–Provider Dispute Resolution (PPDR) process. Please save a copy or photo of your written Good Faith Estimate for your records.
For more information about your rights and the Good Faith Estimate process, visit the official CMS No Surprises website or call 1-800-MEDICARE (1-800-633-4227).
For questions or to request a Good Faith Estimate, contact Samara Therapy Specialists at (406) 830-4500 or hello@samaratherapy.com, or visit our clinic in Missoula, MT.