Right to Receive a Good Faith Estimate

Under Federal law, if you do not have medical insurance or choose not to utilize your medical insurance for specific episodes of care provided, you have the right to receive a “Good Faith Estimate” summarizing the anticipated cost of your medical care.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes fees for office visits and medical tests.
• Your Good Faith Estimate will be provided to you one (1) business day before your medical service. In the event the care is emergent or additional testing is recommended during your visit, you will receive a Good Faith Estimate at the time these services are rendered.
• You may request a Good Faith Estimate before you schedule a service.  The Good Faith Estimate will be based on the information available at the time the service is scheduled.  Please be advised that exact care cannot be determined until you are evaluated by the physician and additional services may be recommended or required.
• If you receive a bill that is at least $400 more than the Good Faith Estimate provided for that care, you may dispute the bill under the new patient-provider dispute resolution process.
• Make sure to save a copy or picture of your Good Faith Estimate

For questions and additional information about your rights under the No Surprises Act, please visit www.cms.gov/nosurprises.