Good Faith Estimate Notice

You have the right to receive a “Good Faith Estimate” explaining how much your healthcare will cost. Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of their bill for services before those services are provided.

• You have the right to receive an estimate for the total expected cost of any non-emergency health care services upon request or when scheduling those services.

• You will be provided with a Good Fatih Estimate in writing at least one business day before your scheduled appointment.

• If you receive a bill that is $400 or 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/consumers