Good Faith Estimate & Your Right to a Good Faith Estimate

Your Right to a Good Faith Estimate

Under Section 2799B-6 of the Public Health Service Act, healthcare providers and facilities are required to give patients who are uninsured or not using insurance an estimate of the bill for medical items and services, called a “Good Faith Estimate,” before those items or services are provided.

Who This Applies To

This right applies if you are not enrolled in a health plan, not enrolled in a federal health care program, or if you are enrolled but not seeking to have a claim submitted to your insurance for the services.

What the Estimate Includes

• An estimate of the expected charges for the services you are requesting, based on information available at the time the estimate is provided.
• A list of the items and services reasonably expected to be provided as part of the requested care.

The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. It is not a contract and does not obligate you to obtain the services from this practice.

How to Request an Estimate

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services, including psychiatric evaluation and ongoing care. You can ask your provider, or any provider or facility you choose, for a Good Faith Estimate before you schedule an item or service, or at any time you request it.

To request a Good Faith Estimate, please contact us through our Contact page at least a few business days before your scheduled appointment.

Your Right to Dispute a Bill

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.

Make sure to save a copy 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.