No Surprise Act Good Faith Estimate

You may have the right to receive a “Good Faith Estimate” explaining how much your health care will cost. Under the law, health care 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.

• The estimate will include the total expected cost for all items or services that we reasonably expect to provide to you at the time of scheduling.
• If you schedule at least 10 days in advance, we will deliver a good faith estimate to you within 3 days of scheduling. If you schedule at least 3 days in advance, we will deliver a good faith estimate to you within 1 day of scheduling. If you schedule less than 3 days in advance, you may not receive a good faith estimate prior to your appointment.
• You may also request an estimate at any time. We will return a good faith estimate within 3 days of your request.
• Make sure to save a copy or picture of your estimate and the bill.
• If you receive a bill that is at least $400 more than your estimate, you can dispute the bill by visiting https://www.cms.gov/nosurprises/consumers.

For questions or more information about your right to a good faith estimate, please visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1- 800-985-3059.