Your Rights Under the No Surprises Act

Access Medical and Health Clinic, PLLC is a cash-based medical clinic. We do not bill or contract with insurance plans for office visits. All clinic services are paid directly by the patient at the time of service.

Because we operate as a self-pay practice, the federal No Surprises Act primarily applies to you as an uninsured or self-pay patient.

Your Right to a Good Faith Estimate

Under federal law, you have the right to receive a Good Faith Estimate explaining the expected cost of your medical care before you receive services.

What This Means for You:

-You may request a written Good Faith Estimate before scheduling a service.

-The estimate will include the expected charges for:

-Office visits

-Procedures performed in our clinic

-In-office testing

-The estimate does not include costs from providers or facilities outside of our clinic (such as labs, imaging centers, pharmacies, or specialists).

We will provide a Good Faith Estimate:

-Within 1 business day if your appointment is scheduled at least 3 business days away

-Within 3 business days if your appointment is scheduled at least 10 business days away

-At any time upon request

If Your Bill Is Higher Than Your Estimate

If you receive a bill from our clinic that is at least $400 more than your Good Faith Estimate, you have the right to dispute the charge.

You must initiate the dispute process within 120 calendar days of the original bill date.

Information about the federal dispute process is available at:

https://www.cms.gov/nosurprises
1-800-985-3059

Services Outside of Our Clinic

Although we do not bill insurance, you may choose to use your insurance for:

-Laboratory testing

-Imaging (X-ray, MRI, CT, Ultrasound)

-Medications

-Specialist referrals

-Hospital care

Those services are billed separately by those facilities and are not included in our Good Faith Estimate.

If you receive emergency care or hospital-based, lab-based services, federal balance billing protections may apply to those providers under the No Surprises Act.

Transparency & Upfront Pricing
As a direct pay clinic in Utah, we believe in:

-Transparent, upfront pricing

-Clear communication about costs

-No hidden facility fees

-No surprise billing

All clinic service fees are provided before treatment whenever possible.

Questions or Requests for a Good Faith Estimate

To request a Good Faith Estimate or ask questions about your bill, please contact:

Access Medical and Health Clinic, PLLC
Phone: 435-610-1415
Email: [email protected]
Address: 40 West Main Street, STE B, Mt. Pleasant, UT 84647