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Galactic Health Alliance

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 - Established patient office or other outpatient visit
81002 - Urinalysis, non-automated, without microscopy


Do internal medicine practices need to provide good faith estimates for their services?

Internal medicine practices must provide good faith estimates to patients who require it.

Are internal medicine practices subject to GFE regulations?

All internal medicine practices are required to follow good faith estimate rules.

What patients at internal medicine practices should be provided with good faith estimates?

Internal medicine 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 

Internal Medicine


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Ensure No Surprises Act compliance for your internal medicine practice without the added expense or stress of hiring additional staff.

Ensure compliance with the legal requirements of the No Surprises Act's Good Faith Estimates without the added expense of hiring full-time GFE-dedicated staff. Our automated email/text estimates are fully HIPAA-compliant and encrypted with two-factor authentication, and we also offer paper estimates for those who prefer it. This service is tailored specifically to meet the needs of internal medicine practices.

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Streamline your practice's operations and save money by automating benefits checks.

Automated eligibility verification helps your internal medicine practice increase efficiency, reduce administrative costs, avoid back-end denials, bill the correct payer, and stay on top of prior-authorization needs. This way, you can handle patient volume growth without sacrificing quality of care or incurring bad debt.

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Improve patient collections and receive payments more quickly, all while enhancing the internal medicine practice experience.

Empower your internal medicine practice's patients to confidently receive care by providing transparent out-of-pocket projections ahead of service. With our online estimates, patients can make deposits directly, saving front-desk staff time and avoiding awkward interactions during the appointment.


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

Get paid in full by bringing clarity to your revenue cycle