Your Right to a Good Faith Estimate

Under the federal No Surprises Act, health care providers are required to give clients who don't have insurance, or who are not using insurance, an estimate of the expected charges for medical items and services.

You have the right to receive a Good Faith Estimate (GFE) that:

• Explains how much your medical and mental-health care will cost before you schedule an item or service, or upon request.
• Covers the expected charges for care reasonably expected to be provided in connection with a scheduled or requested service.
• Is provided in writing at least 1 business day before your service (or, for services scheduled at least 10 business days out, no later than 3 business days after scheduling).

If your bill is $400 or more above your estimate

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill through the federal patient-provider dispute resolution process. You must start the dispute process within 120 calendar days of the date on your bill.

How to get your estimate from this practice

If you are self-pay or not using insurance, request a Good Faith Estimate through the contact page (non-PHI only) or when we speak. You will receive the estimate in writing before scheduling.

Learn more

For questions and more information about your right to a Good Faith Estimate or the dispute process, visit cms.gov/nosurprises or call 1-800-985-3059.

Keep a copy of your Good Faith Estimate. This page describes federal rights and is provided for informational purposes.