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Dermasith Clinic

Good Faith Estimate for Health Care Items and Services

Patient Identification Number: 156749125
Evergreen Ave
Mountain City, CO 34510
The following is a detailed list of expected chargers for the appointment scheduled for 11/2/2023. The estimated costs are valid for 12 months from the date of the Good Faith Estimate.
Details for Services and Items for appointment located at Mountain City:
99213 - Office or other outpatient visit
17311 - Cryotherapy for the destruction of benign lesions other than skin tags or cutaneous vascular proliferative lesions.


Do dermatology practices need to provide good faith estimates?

Dermatology practices are required to provide good faith estimates to patients who request them.

Are dermatologists subject to GFE regulations?

All dermatology practices, including dermatologists and aesthetic specialists, must comply with good faith estimate regulations.

What type of patients at dermatology practices should be provided with good faith estimates?

Dermatology practices must provide uninsured and self-paying patients with good faith estimates as required by the No Surprises Act.

Achieve compliance and boost collections at the same time

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Automatically send Good Faith Estimates via email, text, or letters

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Project out-of-pocket costs

Generate accurate estimates for patients that include deductibles, copays, and coinsurance.

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Unlock upfront payments

Enable patients to make upfront deposits and payment plan elections online, directly from their estimates.

3 wins for your 



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Ensure No Surprises Act compliance for your dermatology practice, without the added expenses or headaches of extra staffing.

Get your dermatology practice up to speed with the legal requirements of the No Surprises Act on Good Faith Estimates. Our automated email/text estimates are fully HIPAA-compliant, encrypted, and include two-factor authentication for patient security. Say goodbye to the expense of hiring full-time GFE-dedicated staff for manually repetitive tasks. And for those who prefer paper estimates, we have that covered as well.

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Streamline your dermatology practice and reduce administrative expenses with automated benefit checks, minimizing bad debt.

Automated eligibility verification can improve the efficiency of your dermatology practice, resulting in reduced administrative costs and improved revenue cycle management. With accurate patient insurance information, you can bill the correct payer, avoid prior-authorization issues, and minimize the risk of back-end denials that can lead to bad debt.

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Enhance revenue from dermatology patients and accelerate payments, while elevating their experience.

Empower your dermatology patients by providing them with clear out-of-pocket projections before their service. This will give them the confidence to make upfront deposits that go beyond their co-pays. With our online estimates, patients can make deposits directly, saving your front-desk staff time and creating a more efficient process.


MD Clarity works with the tools you use to run your practice.

Get paid in full by bringing clarity to your revenue cycle