YOUR RIGHT TO A GOOD FAITH ESTIMATE

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

Uninsured or self-pay patients are entitled to an estimate for medical items and services. Key details to include in your notice:

• Coverage and Scope: Receive a Good Faith Estimate for expected non-emergency costs, including tests, drugs, equipment, and fees.

• Timeline: Providers must supply estimates in writing at least 1 business day before service, and you can request one prior to scheduling.

• Disputes: You may dispute bills that exceed the estimate by $400 or more.

• Record Keeping: Always save a copy or picture of your estimate.

For further assistance, visit the CMS No Surprises Act website or call 1-800-985-3059