Good Faith Estimate Policy
Standard Notice: “Right to Receive a Good Faith Estimate of Expected Charges” Under the No Surprises Act
The following information is being presented to you due to the new federal law called the “No Surprises Act” which went into effect 1/1/2022.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. You have a right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency 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 1 business day before your medical service or item. You can also ask your healthcare provider, or any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you 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.
For questions or more information about your right to a Good Faith Estimate, visit https://www.cms.gov/nosurprises or call this office (or your provider, if different) after you have scheduled an appointment or before your next scheduled appointment.
Understanding costs if you are uninsured or self-pay:
https://www.cms.gov/nosurprises/consumers/understanding-costs-in-advance
Fact Sheet of What you Need to Know about the Administration’s Actions to Prevent Surprise Billing: