Good Faith Estimate Notice

Under Section 2799B-6 of the Public Health Service Act, health care providers and facilities must inform individuals who are not enrolled in a health plan or Federal health care program, or who are not submitting a claim to insurance, of their right to receive a “Good Faith Estimate” of expected charges for health care items and services.

• You have the right to receive a Good Faith Estimate that explains how much your medical care is expected to cost.

• Providers are required to give this estimate to patients who do not have insurance or who are choosing not to use insurance.

• The Good Faith Estimate will include the total expected costs of non-emergency services. This may include medical tests, prescriptions, equipment, and facility fees.

• You may request a Good Faith Estimate before scheduling any item or service, from your provider or any provider of your choice.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the charges.
  

For more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.