Good Faith Estimate | Noor Pediatric Therapy
Federal Patient Right

Your Right to a Good Faith Estimate

Last updated: May 11, 2026

You have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost.

Who this applies to

Under federal law (the No Surprises Act), healthcare providers must give patients who don't have insurance or who are not using insurance an estimate of the bill for medical items and services.

This right applies to you if you are:

  • Uninsured (no health insurance plan covering this service)
  • Insured but choosing not to use your insurance for this service (sometimes called "self-pay")

If you are using insurance, your insurance plan provides you with similar cost information directly.

What the Good Faith Estimate includes

If you ask for a Good Faith Estimate (or schedule a service), we will provide you with a written estimate that includes:

  • A list of services your child is expected to receive (for example, an initial evaluation followed by an estimated number of treatment sessions)
  • The CPT/billing code and a description for each item
  • The expected charge for each item
  • A total expected charge
  • Any items or services the estimate doesn't include and would have to be billed separately

When you'll receive it

If you schedule pediatric therapy services and identify yourself as uninsured or self-pay, we will provide your Good Faith Estimate in writing:

  • At least 1 business day before service, if scheduled less than 10 business days in advance
  • At least 3 business days before service, if scheduled at least 10 business days in advance
  • Within 3 business days if you simply ask for an estimate without scheduling

You can request a Good Faith Estimate at any time, even before you decide to schedule. There is no charge for receiving one.

How to request one

To request a Good Faith Estimate, contact us:

Tell us you'd like a Good Faith Estimate and provide a few details (the type of service you're considering, your child's age, and any relevant background). We'll prepare and send the estimate within the timelines above.

If your final bill is much 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.

To start a dispute, you generally have 120 calendar days from the date on the original bill. There is a small administrative fee to initiate the process (currently $25), which is refunded if the dispute is decided in your favor.

To learn more about the dispute resolution process or to start one:

Keep your Good Faith Estimate

We strongly recommend saving a copy of your Good Faith Estimate for your records. You will need it if you ever choose to dispute a bill.

Questions?

If you have any questions about your right to a Good Faith Estimate, or you'd like help understanding one we've sent you, please contact us using the information above. We're happy to walk through it with you.

This notice is provided in accordance with the federal No Surprises Act (45 CFR §149.610) and the Consolidated Appropriations Act of 2021. For more information, visit www.cms.gov/nosurprises.