You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers and facilities are required to provide patients who do not have insurance or are not using insurance with an estimate of the expected costs of 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 such as medical tests, prescription drugs, equipment, and hospital fees.
• Your health care provider or facility must provide you a written Good Faith Estimate upon scheduling your service or within 1 business day of scheduling.
• You can also request a Good Faith Estimate from any provider or facility before scheduling an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill. You can initiate a dispute by following the instructions provided in your billing statement or by visiting the federal No Surprises Help Desk at www.cms.gov/nosurprises.
• Be sure to save a copy or picture of your Good Faith Estimate for your records.
• If you need the Good Faith Estimate in an alternative format or require assistance, please contact us at [insert phone/email here].

For more information about your rights to a Good Faith Estimate, please visit www.cms.gov/nosurprises.