Good Faith Estimate
Your right to know what your care will cost.
Last updated: November 4, 2026
Our promise
At Revive Chiropractic, we strive to be transparent with all of our patients about all aspects of their healthcare.
It is our promise to provide you with a Good Faith Estimate upon booking by phone or online, again at your third visit or Report of Findings, and throughout your journey of care here however long or short that may be. We do our best to estimate based on the information available from you and/or your insurance company at the time of the estimate. If we receive information that is contrary to the estimate at any time, we will contact the insured within 24 hours of our notice of discrepancy. Together we will come up with a solution for resolving the discrepancy.
We are committed to following all state and federal insurance guidelines when it comes to billing and payments. Please understand that for us to remain compliant in some situations, we may not be able to negotiate upon discovery of a discrepancy between our estimate and your insurance company. Please contact your insurance company to verify benefits. Contact our office if you’d like a list of pertinent questions to ask your insurance company.
Please note that the only insurance company we are a Participating Provider for is Medicare. We do not file for insurance if we are not a Participating Provider or are “Out-Of-Network”.
*Medicare Supplement policies in the State of Wisconsin may cover care per the Wisconsin Mandate for Chiropractic Care – please ask about this specifically when verifying your own benefits. Contact our office with questions.
You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost
Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.
- You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
- If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.
How to get an estimate from us
If you don’t have insurance, or you’re choosing not to use it, tell us when you schedule, or ask us any time before your visit. We’ll give you a written estimate. Please call us at 608-855-9698.
This federal right applies to patients who are uninsured or not using insurance. Because we bill only Medicare, patients with other insurance who pay us directly are covered by it too. Patients enrolled in Medicare, Medicaid (BadgerCare), TRICARE or another federal health care program are covered by those programs’ own billing protections; if you have Medicare and want a service Medicare doesn’t cover, ask us for an estimate. Federal employees with FEHB coverage who choose not to use it are covered by this right. This notice is available in other formats or languages on request.