Disclaimer: These rates do not apply if you elect to use your coverage under any insurance program, including high deductible health plans. If you elect to use health insurance coverage and/or worker’s compensation coverage for health care services, all rates for such services will be determined by your insurers and/or as otherwise determined by Physicians Care for services provided outside of its Self-Pay Program. If you elect to use any insurance program, you will be required to pay your applicable patient responsibility, co-pay, co-insurance, or deductible at the time of service. There may be additional items or services Physicians Care recommends as part of your course of care that must be scheduled or requested separately by you and are not reflected in good faith estimates or above. The information provided in a good faith estimate and/or above is only an estimate regarding items or services reasonably expected to be furnished at the time the good faith estimate is issued (or, in absence of a good faith estimate, in a customary visit for the services described above) and that actual items, services, or charges you receive may differ from the good faith estimate and/or those set forth above. You have the right to initiate a patient-provider dispute resolution process as specified in 45 CFR 149.620, if the actual billed charges are substantially in excess of the charges in a good faith estimate. You may initiate this dispute resolution process by sending a written notice of your dispute addressed to Urgent Team, Attn: Billing Department, 30 Burton Hills Blvd., STE 175, Nashville, TN 37215 or billinginquiry@urgentteam.com. Your initiation of the patient-provider dispute resolution process will not adversely affect the quality of health care services furnished to you by Physicians Care provider(s). Neither a good faith estimate, nor the information provided above, is a contract – you are not required to obtain the items or services from any of the providers identified in a good faith estimate or above.