PromiseCare Medical Group
Effective Date: March 12, 2026
Last Updated: March 12, 2026
Notice: Your Right to a Good Faith Estimate
Under the law, healthcare providers and facilities are required to give patients who do not have insurance, or who are not using their insurance for a service, a written Good Faith Estimate of expected charges before receiving scheduled items or services.
What Is a Good Faith Estimate?
A Good Faith Estimate (GFE) is a written document that tells you, before you receive care, how much your healthcare provider expects to charge you for the items and services associated with your visit or procedure. It is not a final bill — it is a reasonable estimate of what you may owe based on the care your provider expects to provide.
A Good Faith Estimate includes expected charges for:
- The primary service or item you are scheduling
- Related services that are reasonably expected to be provided at the same time, such as laboratory tests, diagnostic imaging, supplies, or anesthesia
- Services provided by other providers or facilities in connection with your scheduled care, if known at the time of scheduling
Who Is Entitled to a Good Faith Estimate?
You have the right to a Good Faith Estimate if:
- You do not have health insurance, or
- You have health insurance but choose not to use your insurance for the scheduled service (self-pay)
If you have insurance and plan to use it for a scheduled service, your insurer’s Explanation of Benefits (EOB) and plan documents provide information about your expected cost-sharing.
Your Rights Under the No Surprises Act
You have the right to receive a Good Faith Estimate in writing at least 1 business day before your scheduled service or item.
You can also ask PromiseCare, or any other provider you are considering, for a Good Faith Estimate before you schedule any item or service.
When you receive your Good Faith Estimate, review it carefully. If you receive a bill that is at least $400 more than your Good Faith Estimate for the same scheduled item or service, you have the right to dispute that bill.
Make sure to save your Good Faith Estimate and any bills you receive. You may need them if you decide to file a dispute.
How to Request a Good Faith Estimate
To request a Good Faith Estimate from PromiseCare Medical Group before scheduling a service, contact us at:
Member Services: (951) 791-1111
Enrollment & Scheduling: (951) 390-2840
TTY: 711
Monday – Friday: 8:00 AM – 5:00 PM
Address: 1545 W. Florida Ave., Hemet, CA 92543
You may also request a Good Faith Estimate at the time of scheduling by asking the staff member who schedules your appointment.
How to Dispute a Bill That Exceeds Your Good Faith Estimate
If you receive a bill that is at least $400 more than your Good Faith Estimate for the same scheduled item or service, you may start a dispute resolution process with the U.S. Department of Health and Human Services (HHS).
To learn more about the dispute resolution process, visit: www.cms.gov/nosurprises
Or call: 1-800-985-3059
You must start the dispute resolution process within 120 calendar days of the date on the original bill that is being disputed.
The cost to use the dispute resolution process is $25. The independent reviewer’s decision is binding on both you and the provider.
More Information
For more information about your rights under the No Surprises Act, including your right to a Good Faith Estimate, visit:
- CMS No Surprises Act: www.cms.gov/nosurprises
- CMS Patient Resources: www.cms.gov/files/document/patient-rights-under-no-surprises-act.pdf
- 1-800-985-3059 — CMS No Surprises Help Desk