Good faith estimate

Good Faith Estimate at Eras

You have the right to receive a Good Faith Estimate of the expected cost of your health care before you receive services. Under federal law, health care providers are required to give patients who are uninsured or who are not using their health insurance an estimate of their bill before services are provided.

1 Who This Notice Applies To

This notice applies to you if, at the time you schedule or request services at Eras Women's Health, you are:

Uninsured — you do not have any health insurance coverage; or
Self-pay — you have health insurance but choose not to submit a claim to your insurer and will pay directly out of pocket; or
Enrolled in short-term, limited-duration insurance and not also enrolled in a group health plan or other qualifying coverage.

This notice does not apply to services billed to Medicare, Medicaid, TRICARE, Veterans Affairs Health Care, Indian Health Services, or other federal health care programs.

2 Your Right to a Good Faith Estimate

Under Section 2799B-6 of the Public Health Service Act, as implemented through the No Surprises Act (effective January 1, 2022), Eras Women's Health is required to provide you with a written Good Faith Estimate of expected charges for any health care items or services you schedule or request, at no charge to you.

A Good Faith Estimate will be provided to you automatically when you schedule an appointment (if the appointment is at least three business days away) and upon your request at any time. You do not need to use the words "Good Faith Estimate" — any question about what your care will cost is treated as a request.

3 When You Will Receive Your Estimate

Scheduled ≥ 10 business days in advance — or requested at any time

We will provide your GFE within 3 business days of the date you schedule or submit your request.

Scheduled 3–9 business days in advance

We will provide your GFE within 1 business day of the date you schedule your appointment.

Changes to your plan of care

If services change materially, we will provide an updated GFE at least 1 business day before the changed services are provided.

Walk-in, urgent, or same-day unscheduled services

The GFE requirement is triggered by a scheduled appointment. A GFE may not be available before same-day urgent services — but you may request cost information at any time.

4 What Your Good Faith Estimate Will Include

Your GFE will be provided in writing (paper or electronic, per your preference) and will include:

The name, NPI, and Tax Identification Number of Eras Women's Health, LLC
An itemized list of all items and services reasonably expected to be provided, including office visits, procedures, labs, and other associated items
The expected charge for each item and service
The diagnosis codes, expected service codes, and service location applicable to your visit
A notice that the GFE is not a contract and does not obligate you to receive services from Eras Women's Health
A notice of your right to dispute a bill that is substantially higher than the estimate

5 Important Limitations and Disclosures

Not a Final Bill

A Good Faith Estimate is based on information available at scheduling. Actual charges may differ depending on the care you receive.

Not a Contract

Receiving a GFE does not require you to obtain services from Eras Women's Health or from any specific provider listed.

Medications Billed Separately

For program members, GLP/GIP therapies are billed separately at cost and will be itemized in your GFE when applicable.

Outside Services

Charges from outside providers (lab, imaging, DEXA) are outside our control and will be disclosed as a separate line item to the extent known.

6 Your Right to Dispute a Bill

If the total bill you receive is $400 or more higher than your Good Faith Estimate, you have the right to initiate the federal Patient-Provider Dispute Resolution (PPDR) process.

How to Initiate a Dispute

Your bill is at least $400 more than the Good Faith Estimate for that provider
You initiate within 120 calendar days of the date you receive your initial bill
You have a copy of your Good Faith Estimate and your bill

Once you initiate the PPDR process, we may not send your bill to collections or accrue late fees while the dispute is pending. Disputing will not affect the quality of care you receive. A non-refundable $25 administrative fee is required to initiate the federal PPDR process.

Visit cms.gov/nosurprises/consumers or call the No Surprises Help Desk at 1-800-985-3059.

7 How to Request Your Good Faith Estimate

You may request a Good Faith Estimate at any time — before or after scheduling — by contacting us using any of the methods below.

Phone

(479) 344-3313

Patient Portal / Secure Message

Passport Patient Portal

In Person

Ask at the front desk when you call or arrive. We'll also verbally notify you of your right to a GFE whenever cost questions arise.

8 Additional Resources and Complaints

If you have questions about your rights under the No Surprises Act, or believe Eras Women's Health has not complied with GFE requirements, you may contact:

Federal — CMS / HHS

cms.gov/nosurprises
No Surprises Help Desk:
1-800-985-3059
TTY: 1-800-537-7697

Arkansas — Insurance Dept.

Arkansas Insurance Department
Consumer Services Division
1-800-852-5494
insurance.arkansas.gov

Legal Notice: This Good Faith Estimate notice is provided in compliance with Section 2799B-6 of the Public Health Service Act and 45 C.F.R. § 149.610. Nothing in this notice constitutes legal advice or establishes a contractual obligation. This policy is subject to change as federal and Arkansas state laws are updated. Last reviewed and updated March 2026. Available in accessible formats and, upon request, in languages other than English.

Eras Women's Health, LLC  ·  Fayetteville, AR  ·  (479) 344-3313  ·  This section satisfies the federal website posting requirement under 45 C.F.R. § 149.610(b)(2).