Your Right to Receive a Good Faith Estimate

Under the No Surprises Act, healthcare providers are required to provide patients who are uninsured or choose not to use their insurance with a Good Faith Estimate of the expected costs for scheduled healthcare services.

If you are paying for your dental care without dental insurance, or if you choose not to submit a claim to your insurance plan, you have the right to receive a written estimate of the expected charges before your treatment.

A Good Faith Estimate helps you understand the anticipated costs of your dental care, allowing you to make informed decisions about your treatment.

---

What Is Included?

Your Good Faith Estimate may include the expected cost of:

• Comprehensive dental examinations
• Digital X-rays and diagnostic imaging
• Preventive care
• Restorative procedures
• Cosmetic treatments
• Periodontal services
• Other recommended dental services that can reasonably be anticipated at the time your estimate is prepared

Please note that additional treatment may become necessary after your examination. If that occurs, your dentist will discuss any recommended changes with you before proceeding whenever possible.

---

Your Rights

As a patient, you have the right to:

• Request a Good Faith Estimate before scheduling treatment.
• Receive a written estimate for expected dental services when you are uninsured or not using insurance.
• Ask questions about your estimated treatment costs before receiving care.
• Receive clear explanations regarding recommended treatment and associated fees.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you may have the right to dispute the charges through the federal patient-provider dispute resolution process.

---

Learn More

For more information about your rights under the No Surprises Act, visit:

https://www.cms.gov/nosurprises

or call the No Surprises Help Desk at:

1-800-985-3059

---

Questions?

If you would like to request a Good Faith Estimate or have questions regarding your treatment costs, our team is happy to help.

Smiles for Health

2656 Gateway Road, Suite 145
Carlsbad, CA 92009

Phone: (760) 297-6216

Email: [email protected]

---

Last Updated: June 30, 2026