Good Faith Estimate

Last updated October 15, 2024

RIGHT TO RECEIVE NOTICE: GOOD FAITH ESTIMATE OF EXPECTED CHARGES

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

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 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 healthcare provider gives you a Good Faith Estimate in writing at least 3 business days 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 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.

As described in the informed consent, you have the right to decide at any time not to receive therapy from me. You have the right to end therapy at any time without any moral, legal, or financial obligation other than those already accrued.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises