Your Right to a Good Faith Estimate

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

Under a federal law (the 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 expected charges for services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services. This includes related costs like collaboration with other providers in the course of your treatment, preparation of documents for court, late-cancellation fees, and other billable items.

• You may request a Good Faith Estimate in writing at least one business day before your service. You can also ask me, and any other provider you choose, for a Good Faith Estimate before you schedule a service.

• The Good Faith Estimate will be provided in a format you can save and print.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

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