Good Faith Estimate Statement

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost  

• Under the law, healthcare providers need to 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 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 1-800-985-3059.