Your Right to a Good Faith Estimate
Notice Required Under the No Surprises Act
Effective January 1, 2022 | 29 C.F.R. § 2590.716-8; 45 C.F.R. § 149.610
Your Right to Know What Your Care Will Cost
Under federal law, health care providers and facilities are required to give patients who do not have insurance — or who are not using their insurance — a written estimate of expected charges before scheduled services are provided.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services before your appointment.
This includes all related costs such as:
- Medical tests and lab work
- Prescription drugs and medications
- Durable medical equipment
- Facility fees and room charges
- Specialist consultations related to your visit
What Is a Good Faith Estimate?
A Good Faith Estimate (GFE) is a written document that tells you, in advance, the expected charges for scheduled services. It is not a final bill and it is not a contract — but it gives you important information about estimated costs so you can make informed decisions about your care.
A Good Faith Estimate must be provided to you:
- At least 1 business day before your scheduled medical service or item
- In writing (paper or electronic, based on your preference)
- At no charge to you
You can also request a Good Faith Estimate before you schedule an appointment. You do not need to wait until after scheduling to ask.
How to Request a Good Faith Estimate
To request a Good Faith Estimate before or after scheduling, contact Nivano Physicians Member Services:
| Contact Method | Details |
|---|---|
| Phone | (916) 407-2000 |
| Toll Free | (844) 889-2273 |
| Medicare Hotline | (916) 407-2000 ext. 82512 |
| 2554 Millcreek Dr., Suite 100, Sacramento, CA 95833 | |
| Office Hours | Mon: 8:00am–10:00am, 1:00pm–4:30pm / Tue–Fri: 8:00am–12:00pm, 1:00pm–4:30pm |
When you call, let us know that you are uninsured or are not using your insurance for the scheduled service, and that you would like a Good Faith Estimate.
If Your Bill Is Higher Than Your Good Faith Estimate
If you receive a bill that is $400 or more above the amount shown on your Good Faith Estimate, you have the right to dispute the bill.
To dispute a bill that exceeds your Good Faith Estimate:
- You must initiate a dispute within 120 calendar days of the date of your bill
- A dispute resolution specialist will review your case
- The dispute resolution process is available for bills over $400 above the GFE amount
- There is a small administrative fee to use the dispute resolution process
For more information about the dispute resolution process, visit:
www.cms.gov/nosurprises
Or call: 1-800-985-3059
Good Faith Estimates for Multiple Providers
If your care involves multiple providers (for example, a primary care visit, specialist referral, and lab work), each provider involved in your care is required to provide their portion of the Good Faith Estimate. Nivano Physicians will coordinate with network providers to provide a combined estimate where possible.
Important Notes
- A Good Faith Estimate does not require you to receive the listed services
- A Good Faith Estimate does not require Nivano Physicians or any network provider to provide services at the estimated cost if your medical situation changes
- If you have insurance and choose to use it, different cost-sharing rules apply — ask your health plan about your expected out-of-pocket costs
- This notice applies to uninsured patients and patients who choose not to use their insurance for a scheduled service
Additional Resources
| Resource | Contact |
|---|---|
| CMS No Surprises Act Information | www.cms.gov/nosurprises |
| Patient Dispute Resolution | 1-800-985-3059 |
| Nivano Physicians Member Services | (916) 407-2000 |
| State Health Insurance Assistance Program (SHIP) | www.shiphelp.org |
| California Department of Managed Health Care Help Center | 1-888-466-2219 |
For Providers in Our Network
Providers in the Nivano Physicians network who schedule services for uninsured or self-pay patients are required to:
- Provide a Good Faith Estimate at least 1 business day before the scheduled service
- Retain a copy of the GFE for at least 6 years
- Post this notice in their office at scheduling locations and on their website
For questions about Good Faith Estimate requirements, network providers may contact Nivano Physicians Provider Services at (916) 407-2000 or compliance@nivanophysicians.com.
This notice is provided in compliance with the No Surprises Act (Pub. L. 116-260) and implementing regulations at 29 C.F.R. § 2590.716-8 and 45 C.F.R. § 149.610. This notice was last reviewed on March 11, 2026.
Nivano Physicians, Inc.
2554 Millcreek Dr., Suite 100 | Sacramento, CA 95833
(916) 407-2000 | www.nivanophysicians.com