Good Faith estimate notice

You have the right to receive a Good Faith Estimate explaining how much your medical care will cost.

Under the law, health care providers need to give patients who do not have insurance or are not using insurance an estimate of the bill for medical items and services.

• 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.

• You will receive a Good Faith Estimate in writing at least one business day before your appointment. You may also ask your health care provider for a Good Faith Estimate before you schedule.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

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