Insurance & Pricing
Good Faith Estimate
Understand expected charges and your rights before receiving care.
Patient rights
Your Right to a Good Faith Estimate
You have the right to receive a Good Faith Estimate explaining how much your medical care will cost.
What is a Good Faith Estimate?
It is a written estimate of the charges for services your provider reasonably expects you will need, based on the information available when it is prepared. It is not a bill, treatment recommendation or promise of insurance reimbursement.
Who can request an estimate?
Anyone may contact our office to discuss expected costs. Federal Good Faith Estimate rights generally apply to eligible uninsured or self-pay patients. Medicare and Medicare Advantage requirements must be reviewed separately; an estimate does not waive them.
If you do not have health insurance or are not using it to pay for your care, federal law generally requires a written Good Faith Estimate of expected charges when you request one or schedule care at least 3 business days in advance.
- Care scheduled 3–9 business days in advance: the estimate is generally provided within 1 business day of scheduling.
- Care scheduled 10 or more business days in advance: the estimate is generally provided within 3 business days of scheduling.
- Estimate requested before scheduling: the estimate is generally provided within 3 business days of your request.
The estimate is not a bill. Keep a copy. If a provider bills you at least $400 more than that provider’s estimate, you may qualify for the federal patient-provider dispute resolution process. Applicable eligibility and filing deadlines apply; CMS explains the process, including the 120-calendar-day filing window from the initial bill. Read CMS dispute guidance.
For questions or to request your written estimate, call (781) 901-2482. A pricing table does not replace your individual Good Faith Estimate.
Full Good Faith Estimate rights notice
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 CMS consumer rights, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.
Keep your estimate to compare with your bill. You can request your estimate on paper or electronically, in your preferred format.
Original CMS model notice (PDF)Sample Treatment Cost Estimates
The examples below use procedure-specific average visit counts published by Optimum Therapies, recalculated with VITALIS Orthopedic & Pain prices. These are external reference averages—not VITALIS patient averages, required visit counts or clinical recommendations. Your recommended visits and costs depend on your evaluation, surgical precautions and individual needs.
For these VITALIS calculations, each total includes one initial evaluation ($195) and the remaining visits as 60-minute follow-up sessions ($155 each). Formula: $195 + (total visits − 1) × $155.
| Surgery / Condition | Reference Average Visits | VITALIS Estimated Total |
|---|---|---|
| Bunionectomy | 71 evaluation + 6 sessions | $1,125 |
| Carpal Tunnel | 81 evaluation + 7 sessions | $1,280 |
| Hip Arthroscopy | 101 evaluation + 9 sessions | $1,590 |
| Knee Arthroscopy | 121 evaluation + 11 sessions | $1,900 |
| Total Hip Replacement | 121 evaluation + 11 sessions | $1,900 |
| Achilles Repair | 121 evaluation + 11 sessions | $1,900 |
| Microdiscectomy / Laminectomy | 121 evaluation + 11 sessions | $1,900 |
| Cervical Fusion / Disc Replacement | 121 evaluation + 11 sessions | $1,900 |
| Total Knee Replacement | 131 evaluation + 12 sessions | $2,055 |
| Shoulder Arthroscopy / Debridement | 151 evaluation + 14 sessions | $2,365 |
| ACL Reconstruction | 161 evaluation + 15 sessions | $2,520 |
| Lumbar Fusion | 161 evaluation + 15 sessions | $2,520 |
| Rotator Cuff Repair | 181 evaluation + 17 sessions | $2,830 |
Example: total knee replacement uses the reference average of 13 visits: $195 + 12 × $155 = $2,055. This is a cost illustration, not a recommended treatment duration or a personalized written Good Faith Estimate.
Source: Optimum Therapies — Sample Treatment Cost Estimates. Visit averages are their examples, not a Massachusetts or federal requirement. The one-evaluation calculation above is VITALIS’s stated illustration convention, not a claim about the reference practice’s billing.
Your individual estimate should identify the expected services, visit frequency, period of care and charges that apply to you. Your therapist’s evaluation guides recommendations; the office prepares your estimate. These examples add no unconfirmed travel charges or other fees.
Can the estimate change?
An estimate reflects reasonably expected care, not every possible unexpected service. If your expected services or plan change, ask our office to explain the revised costs and provide an updated written estimate as applicable. A change does not remove your billing-dispute rights.
Before your visit
- Call to request your written estimate before scheduling.
- Ask what services and expected visits the estimate includes.
- Request paper or electronic delivery in your preferred format.
- Keep the estimate and compare it with your bill.
Payment FAQs
Do you currently accept insurance?
We are currently private pay only and are not in-network with any health insurance plans. Credentialing is in progress.
Can I use PPO or out-of-network benefits?
Possibly, depending on your commercial plan. Confirm benefits, deductibles, authorizations and submission rules with your insurer. A PPO label does not guarantee coverage. Reimbursement is not guaranteed.
Can I request a superbill?
Ask our office before your visit. An accurate superbill may be available when appropriate; it does not establish eligibility or guarantee reimbursement. Medicare has separate requirements.
Do I need a referral?
Massachusetts generally allows you to see a physical therapist without a physician referral. Your therapist will assess whether physical therapy is appropriate and may recommend evaluation by another healthcare professional. Direct access does not guarantee insurance payment: your plan may require a referral, prior authorization or other documentation. Medicare coverage has additional requirements.
When do I pay?
Payment is due at the time of service. Contact our office beforehand with questions.
What is your cancellation policy?
Please contact our office for the current cancellation and rescheduling terms before booking.
How do I request a Good Faith Estimate?
Call our office using Request a Good Faith Estimate. Uninsured and self-pay patients may request a written estimate before scheduling. The posted rates do not replace an individual estimate.
What if I have Medicare?
Please call before scheduling so our office can review the applicable eligibility and billing requirements. Private pay is not an unrestricted substitute for Medicare-covered therapy.