Standard Notice: Good Faith Estimate
“Right to Receive a Good Faith Estimate of Expected Charges”
Under the No Surprises Act
Under this new law, health care providers are required to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. Your rights under this law include:
- The right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes costs like medical tests, prescription drugs, equipment, and hospital fees.
- The right for your health care provider to give you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also request a Good Faith Estimate before you schedule an item or service.
- The right to dispute the bill if you receive a bill that is at least $400 more than your Good Faith Estimate.
- The right to retain a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or talk with your provider.