Right to Receive Good Faith Estimate Notice

You Have the Right to Receive a “Good Faith Estimate” Explaining How Much Your Medical Care Will Cost

Click here to download a PDF of this notice

Under the No Surprises Act, healthcare providers are required to give patients who are uninsured, have decided not to use their insurance, or if the patient’s insurance plan is out-of-network with the provider an estimate of the bill for medical tests 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 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 800-985-3059