You have the right to receive a “Good Faith Estimate” explaining how much your care will cost

Under the law, health care providers need to give patients who don’t have certain types of health care coverage, or who are not using certain types of health care coverage, an estimate of their bill for health care items and services before those items or services are provided.

• You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
• If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visitwww.cms.gov/nosurprises/consumers, emailFederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.

This notice is provided in accordance with the No Surprises Act (45 CFR 149.610). It informs you of your rights; no action is required. The Good Faith Estimate is not a contract and does not obligate you to accept the services listed.