Notice of Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost

• Under the law, health care providers are required to give patients who don’t have insurance or who are not using insurance an estimate of their bill for health care items and services that are scheduled at least three business days in advance, or upon request.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency health care 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 one business day before your medical service. 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.

• If you are uninsured or not using your insurance to pay for your health care services, and receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

• Make sure to save a copy or picture of your Good Faith Estimate and the bill.

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