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PATIENT RESOURCES

Available For Download

Patient Forms

Good Faith Estimate 

Notice of Privacy Practice 

Insurance Plans Most Frequently Seen Include 

Blue Shield of California PPO 

Corvel- Care IQ 

Imperial Health Holdings 

Medicare (Part B)

Nivano Physicians

OneCall Physical Therapy 

Partnership 

River City Medical Group 

United Healthcare PPO 

WellSpace Nexus 

Good Faith Estimate 

In accordance with the law, health care providers are required to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. 

  • You may ask your health care provider for a Good Faith Estimate before you schedule your Initial Physical Therapy Appointment.​

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.​

  • All estimated costs are valid for 12 months from the date of the Good Faith Estimate.

  • Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises 

©2022 by Spring Physical Therapy 

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