Good Faith Estimate Notice

You have the right to receive a “Good Faith Estimate” that explains the expected cost of your medical care.

By law, health care providers must offer an estimate of the costs for medical services and items to patients who do not have insurance or are not using insurance.

You have the right to a Good Faith Estimate for the total expected cost of non-emergency services or items. This includes additional costs such as medical tests, prescriptions, equipment, and hospital fees.

Ensure that your health care provider gives you the Good Faith Estimate in writing at least 1 business day before your service or treatment. You can also request a Good Faith Estimate from any provider before scheduling a service or item.

If you receive a bill that is $400 or more above your Good Faith Estimate, you can dispute the charges.

Be sure to keep a copy or a photo of your Good Faith Estimate for your records.

For more information about your right to a Good Faith Estimate or how to dispute a bill, visit www.cms.gov/nosurprises or call CMS at 1-800-985-3059.