You Have the Right to Receive A “Good Faith Estimate” Explaining How Much Your Health Care Will Cost.

Under the no surprises Act (effective Jan ,1 2022) health care providers need to give clients or patients who do not health insurance or who are not using insurance (“Uninsured/Self-Pay Patients”) an estimate of their bill for health care items and services before those items or services are provided.

If you are an Uninsured or Self-Pay Patient, you have the right to receive a Good Faith Estimate for the total expected cost of any healthcare items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

Federal law allows you to dispute the bill if your expected costs are $400 or more than your Good Faith Estimate.

This GFE does not include any unknown or unexpected costs that may arise during treatment.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.