Good Faith Estimate Notice

Your Right to a Good Faith Estimate

Under the No Surprises Act, you have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost.

What this means for you:

Under the law, healthcare providers must give patients who don't have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services, including psychotherapy services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• Make sure your healthcare provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule a 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 www.cms.gov/nosurprises or call 1-800-985-3059.