Your Right to a Good Faith Estimate
Under the federal No Surprises Act, health care providers must 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 of 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 health care 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.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
Requesting an estimate from us
Contact us at [practice email] or [practice phone]. We will provide a written estimate for your evaluation and expected follow-up visits.