Right to Receive a Good Faith Estimate

No insurance or choose not to use your insurance? You have the right to a Good Faith Estimate of your medical care costs.

Under the law, patients who don’t have insurance, choose not to use insurance, or are receiving care from an out-of-network provider and do not have out-of-network health insurance benefits have the right to receive an estimated bill that outlines their out-of-pocket costs for medical items and services before proceeding with medical care.

A Good Faith Estimate provides a fair and honest estimate of the total expected cost of scheduled services, including medical tests, prescription drugs, equipment and hospital fees.

If you wish to receive a Good Faith Estimate, be sure to:

• Schedule your medical service(s) at least three (3) business days in advance of the appointment; or
• Request a Good Faith Estimate before you schedule medical services.

Please make a copy or take a picture of your Good Faith Estimate for your records. If, after receipt of your medical service(s), you receive a bill that exceeds your Good Faith Estimate by $400 or more, you will have the opportunity to dispute the charges.

For questions or more information about your right to receive a Good Faith Estimate, visit Cms.gov/NoSurprises/Consumers or call 866-771-7266.