Good Faith Estimate

You have the right to receive a Good Faith Estimate that outlines the expected cost of your care.

In accordance with federal law, health care providers are required to provide an estimate to individuals who are uninsured or who choose not to use their insurance. This estimate helps you understand the anticipated cost of services before you receive them.

• You are entitled to a written Good Faith Estimate that includes the total expected cost of non-emergency services. This may also include related expenses such as assessments, recommended services, or other associated fees.

• Your provider should give you this estimate in writing at least one business day prior to your scheduled service. You may also request a Good Faith Estimate at any time before booking an appointment.

• If you are billed at least $400 more than the estimate you received, you have the right to dispute the charge.

• It’s important to keep a copy (digital or printed) of your Good Faith Estimate for your records.

For additional details about your rights under the No Surprises Act, you can visit www.cms.gov/nosurprises or contact the Help Desk at 1-800-985-3059 (TTY: 1-800-985-3059).