No Surprises Act & Good Faith Estimate Notice

Your Right to a Good Faith Estimate

Under the federal No Surprises Act, health care providers are required to give patients who don't have insurance, or who are not using their insurance, an estimate of expected charges for scheduled items and services.

Septima Women's Health & Lifestyle is a direct-pay practice. Every patient is entitled to receive a Good Faith Estimate (GFE) before any scheduled visit or procedure.

What the Estimate Includes

Your Good Faith Estimate will show the expected costs of the specific services you've scheduled, itemized clearly, and will include:

• The specific service(s) being scheduled, with associated diagnosis and procedure codes
• The expected charge for each item or service
• Our name, National Provider Identifier (NPI), and Tax Identification Number

How to Request an Estimate

You have the right to receive a Good Faith Estimate at any time — including before scheduling an appointment, or at the time you schedule one. To request a written estimate, contact our office at hello@septimahealth.com or through your patient portal, and we'll provide it in writing within the timeframe required by law.

Medicare Opt-Out Notice

Heather Vincent, PA-C has opted out of the Medicare program. This means:

• Septima Women's Health & Lifestyle does not submit claims to Medicare for any services provided.
• Medicare will not reimburse patients for services received at Septima, even if the service would normally be covered.
• Patients with Medicare coverage are responsible for paying in full, directly, at the time of service.
• Medicare beneficiaries have the right to instead seek care from a provider who has not opted out of Medicare.

Medicare patients seeking non-emergency care at Septima will be asked to sign a private contract acknowledging this arrangement before receiving services, as required by federal regulation.

If Your Bill Is Higher Than Expected

If your actual charges are substantially higher than what was included in your Good Faith Estimate (generally $400 or more above the estimate), you have the right to dispute the bill.

You may be eligible to start a dispute resolution process by contacting the U.S. Department of Health and Human Services (HHS) at the number below. Initiating a dispute will not affect the quality of care you receive from Septima.