Financial Policy & Good Faith Estimate Notice

Effective date: November 2, 2026

Marty Ross MD Clinic is a cash-pay practice. We do not bill insurance, Medicare, or Medicaid. This policy explains what things cost, when you pay, and the estimate rights you have as a self-pay patient under the federal No Surprises Act.

Fees and payment

Current fees for each appointment type are listed on our booking page. Payment is collected after your appointment is complete. We accept cash and checks in the clinic, and Visa, MasterCard and American Express, processed through Square. A $25 fee applies to returned checks.

Some work is charged separately: completing forms such as disability paperwork, writing letters, and prior authorizations that take Dr. Ross more than 15 minutes. We tell you the cost before we do the work.

Insurance

We do not participate in any insurance plans. For in-clinic care, we give you a completed CMS-1500 (HCFA) claim form that you can send to your insurer for possible out-of-network reimbursement. Remote consultations are not covered by insurance. We make no promise that your insurer will pay any part of a visit; that is between you and your insurer.

Cancellation and refunds

Cancel or reschedule at least one full business day before your appointment: 24 hours, counting Monday to Friday only, so for a Monday appointment cancel by the Friday before. Later cancellations and missed appointments are charged $170.50 for each 15 minutes the appointment was scheduled (for example, $341 for a 30-minute appointment), and the charge must be paid before you rebook. This applies to every appointment type, including remote consultations. We do not take deposits, so there is nothing to refund when you cancel in time. If the clinic cancels, we reschedule at no charge.

Good faith estimate (No Surprises Act)

Under the No Surprises Act, if you are uninsured or paying without insurance, you have the right to a good faith estimate of the expected charges for scheduled care.

  • We give you an estimate when you schedule a service at least 3 business days ahead, and within 3 business days of any request, even if you have not scheduled anything. Email reception@martyrossmd.com.

  • If you schedule a service at least 3 business days in advance, we provide the estimate within 1 business day. If you schedule at least 10 business days in advance, we provide it within 3 business days.

  • The estimate covers the services you scheduled. If more services are recommended during your visit, you may request a new estimate first.

  • The estimate is not a bill. Actual charges may differ if your care changes.

If your bill is more than the estimate

If you are charged at least $400 more than your good faith estimate, you may start a patient-provider dispute resolution process:

  1. Ask us to review the bill first; contact reception@martyrossmd.com.

  2. You may start the federal patient-provider dispute process within 120 calendar days of the date on the bill. There is a $25 fee, which is credited back to you if the decision goes your way.

  3. You may need a copy of the estimate, the bill, and proof of your payment. Keep them.

Contact

Financial questions: reception@martyrossmd.com.