Your Right to a Good Faith Estimate

You generally have the right to receive a Good Faith Estimate if:

• You do not have health insurance; or
• You have health insurance but are not using your health insurance to pay for the healthcare items or services you are seeking.

The Good Faith Estimate is intended to help you understand the expected cost of non-emergency healthcare before receiving the applicable services.

• If you schedule a healthcare item or service at least 3 business days in advance, you generally have the right to receive a Good Faith Estimate before the scheduled service.
• If an item or service is scheduled 3 to 9 business days in advance, the Good Faith Estimate generally must be provided within 1 business day after scheduling.
• If an item or service is scheduled 10 or more business days in advance, the Good Faith Estimate generally must be provided within 3 business days after scheduling.
• You may also request a Good Faith Estimate before scheduling an item or service. In that situation, an estimate generally must be provided within 3 business days after the request.

A Good Faith Estimate provides an estimate of the expected charges for healthcare items and services reasonably expected to be provided based on the information available when the estimate is prepared.

The Good Faith Estimate is not a bill or a contract and does not require you to receive the listed services.

Actual charges may differ if your healthcare needs change or if additional or different services become medically necessary.

Other physicians, facilities, imaging centers, laboratories, pharmacies, or healthcare professionals involved in your care may bill separately and may be responsible for providing their own estimates when required by applicable law.

For applicable services provided or coordinated through California Back and Pain Specialists, uninsured or self-pay patients may request a Good Faith Estimate by contacting:

When contacting the practice, please indicate that you are requesting a Good Faith Estimate and provide sufficient information regarding the healthcare service or procedure you are considering so that the practice can prepare an appropriate estimate.

If you receive a bill from a healthcare provider that is at least $400 more than the amount listed for that provider on your Good Faith Estimate, you may be eligible to dispute the bill through the federal patient-provider dispute resolution process.

You should keep a copy of your Good Faith Estimate and any bills you receive.

For additional information regarding Good Faith Estimates, your rights under the No Surprises Act, or the patient-provider dispute resolution process, visit the Centers for Medicare & Medicaid Services (CMS) website or contact the federal No Surprises Help Desk at 1-800-985-3059.

• The information on this page is intended to inform patients of their rights regarding Good Faith Estimates under applicable federal law.
• Good Faith Estimates for services provided or coordinated through California Back and Pain Specialists are handled by the practice based on the particular services anticipated and the patient's individual circumstances.
• A Good Faith Estimate reflects the items and services reasonably expected based on information available when the estimate is prepared. It does not guarantee the final cost of treatment.
• Additional or different services may become necessary based on your medical condition, evaluation, response to treatment, or other circumstances.
• Services provided by other healthcare professionals, facilities, laboratories, imaging centers, pharmacies, or other entities may result in separate charges.

Questions regarding expected charges, billing, payment arrangements, or Good Faith Estimates for services provided through California Back and Pain Specialists should be directed to:

Last Updated: October 4, 2026