Good Faith Estimate

Under federal law, you have the right to receive a Good Faith Estimate explaining the expected cost of your medical care. Health care providers are required to provide this estimate to patients who do not have insurance or who choose not to use insurance.

• You are entitled to a Good Faith Estimate for the total expected cost of any non-emergency medical items or services. This includes related costs such as medical tests, prescription drugs, equipment, and facility fees.

• Your healthcare provider must give you a written Good Faith Estimate at least 1 business day before your scheduled service or item. You may also request an estimate before scheduling.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the charges. Be sure to keep a copy of your estimate for reference.

For questions or more information about your rights regarding a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 1-800-985-3059.