Dental Procedure Good Faith Estimate
Recently, a federal law was passed requiring medical facilities to provide self-pay patients with an estimate for the cost of services. This is an estimate only and no payment is required at this time. You have scheduled an appointment at One Community Health and our records indicate that you have no insurance. If our records are incorrect, please call us at 541.386.6380 x11598 with your insurance information and we will update our records. For our uninsured patients, we offer an approximate cost for the services you can expect to receive at your dental appointment. Due to a wide range of service options, the cost of an office visit at One Community Health varies. Your office visit level will vary depending on the length of your visit and complexity of your care. Please find below the price range of each type of dental visit available at OCH.
There may be additional items or services the convening provider or convening facility recommends as part of the course of care that must be scheduled or requested separately and are not reflected in the good faith estimate. We look forward to greeting you at your visit to One Community Health. Please do not hesitate to contact us with any questions or concerns at (541)386-6380.
Disclaimers:
The information provided in the good faith estimate is only an estimate regarding items or services reasonably expected to be furnished at the time the good faith estimate is issued to the uninsured (or self-pay) individual and that actual items, services, or charges may differ from the good faith estimate. This does not include other providers' charges, or any other services billed outside of OCH or any unknown or unexpected costs that may arise during your visit.
The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. The uninsured (or self-pay) individual has the right to initiate the patient-provider dispute resolution process if the actual billed charges are substantially in excess of the expected charges included in the good faith estimate, as specified in § 149.620; if you receive a bill that is at least $400 more than a Good Faith Estimate, or if you just want to discuss your bill, give us a call at 541-386-6380 and enter extension 11598. We’ll do our best to make things right and share other ways you might be able to save on your healthcare bills. The initiation of the patient-provider dispute resolution process will not adversely affect the quality of health care services furnished to an uninsured (or self-pay) individual by a provider or facility.
The good faith estimate is not a contract and does not require the uninsured (or self-pay) individual to obtain the items or services from any of the providers or facilities identified in the good faith estimate.
For additional information about the No Surprise Act, please visit www.cms.gov/nosurprises.