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Jedi Eye Care Center

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:
92014 - Comprehensive eye exam, established patient
92250: Fundus photography with interpretation and report


Do ophthalmology practices need to provide good faith estimates?

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

Are ophthalmologists subject to GFE regulations?

Good faith estimate rules apply to all eye care providers, including ophthalmology surgical centers and optometrists.

What type of ophthalmology patients should be provided with accurate and transparent cost estimates?

Ophthalmology 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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Attain No Surprises Act compliance for your ophthalmology practice without additional staffing expenses or hassles

Our solution can assist ophthalmology practices in becoming compliant with the legal requirements of the No Surprises Act regarding Good Faith Estimates. This spares the expense of recruiting full-time staff dedicated purely to GFEs, a task that is often repetitious. When patients are given our automated email or text estimates, they are secure, HIPAA-compliant, and encrypted with two-factor authentication. For those who prefer paper estimates, we can provide that option as well.

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Streamline benefit checks for ophthalmology practices and lower administrative costs while reducing bad debt with automated processes

Automated eligibility verification helps your ophthalmology practice increase efficiency and reduce administrative costs, as patient volume grows. It also ensures accurate billing to the correct payer, alerts you when prior-authorization is needed, and prevents back-end denials, ultimately reducing bad debt.

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Enhance your ophthalmology practice's revenue by accelerating patient collections while simultaneously elevating their experience

Give your ophthalmology patients peace of mind when it comes to their finances by providing clear out-of-pocket projections before service. Encourage them to make upfront deposits through our convenient online estimates, eliminating any discomfort or inconvenience at your front desk during their visit.


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

Improve your financial performance while providing a more transparent patient experience