Good Faith Estimate Notice


Per the “No Surprise Act”, you are entited to receive a “Good Faith Estimate” explaining how much your medical care will cost before we begin services.

Under Section 2799B-6 of the Public Health Service Act, health care providers are required to inform individuals who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services, including mental health 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 a 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.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.