"No Surprises Act"
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” of expected charges. 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 for the total expected cost of any non-emergency items or services.
Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your service. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
The services/prices below are general estimated costs. Clients will be provided an individualized Good Faith Estimate to sign when requesting services.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call (800) 368-1019
Request a Good Faith Estimate
When requesting a Good Faith Estimate, you will need to describe the type of service you are requesting and how often you want to meet. If there is availability, I will provide you with a GFE. If there is no availability, the I will provide you with referrals to other providers.