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Good Faith Estimate

You have the right to receive a "Good Faith Estimate" explaining how much your medical 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.

  • You have the right to receive a Good Faith Estimate (GFE) for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs delivered at the time of service, equipment, and hospital fees.
  • If you schedule your appointment in at least 10 business days – or are just inquiring about how much a service will cost, you can expect to receive your GFE within 3 business days. If you schedule your appointment less than 10 business days, but more than 3 business days out, you can expect your GFE in 1 business day. We are not required to issue a GFE for appointments scheduled less than 3 business days out.
  • The estimated costs are valid for 12 months from the date of the GFE.
  • The GFE is an estimate of services only and cannot be expected to be the final overall charges. If your condition is discovered to be more complex once you present to the appointment or develops into more of an issue than originally perceived, you may need additional testing or treatment that is not covered under your GFE. Other GFE’s for those services can be obtained.
  • The GFE is not considered a contract and does not require you to schedule or obtain the items or services listed.

DISCLAIMER

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created. You could be charged more if complications or special circumstances occur. PLEASE KEEP A COPY OF YOUR GOOD FAITH ESTIMATE FOR YOUR RECORDS, YOU MAY NEED IT IF YOUR FINAL CHARGES ARE HIGHER THAN THE ESTIMATE. If the final charges are substantially higher (at least $400 more than the estimate) you can dispute the bill.

The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. If the billed charges are substantially in excess of the expected charges, federal law allows you to dispute (appeal) the bill within 120 days. For questions or more information about your rights to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call the federal surprise billing hotline at 1-800-985-3059.

To receive your "Good Faith Estimate", contact your physician or provider's office.