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Good Faith Estimate

You, as a patient, have the right to receive a "Good Faith Estimate" that details the anticipated costs of your medical care, especially pertinent if you are uninsured or elect not to use insurance. This estimate will encompass the total expected cost for any non-emergency services, items, or procedures, including but not limited to, medical tests, prescription drugs, medical equipment, and hospital fees. By law, your healthcare provider is obligated to provide this estimate in writing at least one business day prior to your scheduled service or item. Additionally, you are encouraged to proactively request a Good Faith Estimate from your healthcare provider or any other provider you are considering, before scheduling any service.

In instances where your final bill is at least $400 more than your Good Faith Estimate, you retain the right to dispute the bill. It is advisable to keep a copy or a photograph of your Good Faith Estimate for future reference. For more detailed information about your rights to a Good Faith Estimate or the process for disputing a bill, please visit www.cms.gov/nosurprises or contact CMS helpline at 1-800-985-3059.

 

Please note that the estimate provided is based on the services and items anticipated at the time of issuance. Additional services or items that may be recommended as part of your care could result in separate charges. It is also important to understand that the actual services, items, or charges may vary from the estimate provided. Should there be a significant discrepancy between the billed charges and the Good Faith Estimate, you have the right to initiate a dispute resolution process. This process will not impact the quality of healthcare services you receive. Lastly, this Good Faith Estimate is not a binding contract and does not obligate you to receive services or items from any specified provider or facility.

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