Self Pay Standard Notice

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

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • 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 medical tests, prescription drugs, equipment, and hospital fees.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Make sure to save a copy or picture of your Good Faith Estimate.

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

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Locations

NORTH OFFICE

5505 Peachtree-Dunwoody Rd.,
Suite 300
Atlanta, GA 30342

404-257-0814

404-843-8521

SOUTH OFFICE

1903 Phoenix Blvd,
Suite 100
College Park, GA 30349

770-996-6664

770-994-9030

WEST OFFICE & SURGERY CENTER

3200 Downwood Circle,
Suite 240
Atlanta, GA 30327

404-355-7000

404-355-8797

Office Hours

Monday - Friday: 8:30AM - 5:00PM
Saturday & Sunday: Closed

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