No Surprises Act/Good Faith Estimate

You have the right to a “Good Faith Estimate” that details the expense of your medical treatment.

Health care providers are required by law to provide an estimate of the price for medical items and services to individuals who do not have insurance or who do not use insurance.

You are entitled to a Good Faith Estimate for the total anticipated cost of any non-emergency items or services. This includes fees for medical tests, prescription drugs, equipment, and hospital stays.

Make sure you get a Good Faith Estimate in writing from your health care provider at least one working day before your medical treatment or item. You can also request a Good Faith Estimate from your health care practitioner, as well as any other provider you choose, before scheduling an item or service.

You have the right to dispute a bill that is at least $400 more than your Good Faith Estimate.

Make sure to save a copy of your Good Faith Estimate.

Visit www.cms.gov/nosurprises or contact 1-800-985-3059 if you have any questions or would like more information regarding your right to a Good Faith Estimate.