You have the right to receive a Good Faith Estimate explaining how much your medical care will cost. Under the law, health care providers must provide clients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services.

Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service. You can also ask your health care provider for a Good Faith Estimate before you schedule a service. This Good Faith Estimate is only an estimate which may be subject to change and may not reflect the overall total charges. There may be additional items or services not contained in this Good Faith Estimate to be recommended by your convening provider as part of your course of care.  If new or additional services are recommended for a future date, you will be provided with an updated Good Faith Estimate prior to that upcoming service.  If service(s) is/are recurring, then the estimated costs included on the Good Faith Estimate are valid for 12 months from the date of the Good Faith Estimate, unless we provide you with an updated Estimate. This Good Faith Estimate is not a contract, and you are not obligated to obtain the items and/or services mentioned on the estimate, you may decline at any time if you so choose.  If the actual amount billed exceeds the expected charges included in this Good Faith Estimate by $400 or more, it is your individual right to initiate the client-provider dispute resolution process.  Make sure to save a copy or picture of your Good Faith Estimate.

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

Download the No Surprises Act & Good Faith Estimate