Good Faith Estimate / No Surprises Act Disclosure
Effective Date: January 1, 2026
This notice is provided in compliance with the federal No Surprises Act (NSA) and applies to patients who do not have insurance or who choose not to use insurance.
Your Right to a Good Faith Estimate
You have the right to receive a Good Faith Estimate (GFE) explaining how much your medical care is expected to cost.
A Good Faith Estimate shows the expected charges for non-emergency medical services provided by J H DAS MD LLC, including subscription fees and other reasonably anticipated services. The estimate is based on the information known at the time it is prepared.
What Is Included
Your Good Faith Estimate may include subscription fees for medical weight-loss services, intake or enrollment fees, and follow-up visit fees (if applicable).
What Is Not Included
The Good Faith Estimate does not include medication costs, pharmacy dispensing or shipping fees, laboratory testing fees, or charges from third-party laboratories or pharmacies. These services are billed separately by third parties and are not controlled by the Clinic.
How to Receive a Good Faith Estimate
A Good Faith Estimate will be provided upon request and as otherwise required by law. You may request a Good Faith Estimate before scheduling services or at any time prior to enrollment.
Billing Disputes
If you receive a bill that is at least $400 more than your Good Faith Estimate, you may have the right to dispute the bill.
For more information about your rights under the No Surprises Act, visit:
https://www.cms.gov/nosurprises
Contact
J H DAS MD LLC
Email: inquiries@das.md
Phone: (352) 448-5748