No Surprises Act Notice
Your Right to Receive a Good Faith Estimate
If you are uninsured or choosing not to use insurance, federal law requires healthcare providers to offer a “Good Faith Estimate” (GFE) of the anticipated costs for your medical care. This GFE helps you understand and plan for expenses related to non-emergency items and services, such as medical tests, prescription drugs, equipment, and hospital fees.
Right to a GFE: You have the right to receive a Good Faith Estimate that outlines the total expected cost before you receive non-emergency items or services.
When You’ll Receive It: Your healthcare provider must give you this estimate in writing at least one business day before your scheduled service. You can also request a GFE from any other provider you choose before scheduling.
Disputes: If you receive a bill that exceeds your Good Faith Estimate by $400 or more, you have the right to dispute the charges.
Record Keeping: Be sure to keep a copy or a photo of your Good Faith Estimate for your records.
For more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.