NO SURPRISES ACT

YOUR RIGHT TO A “GOOD FAITH ESTIMATE”

You have the right to receive a ‘Good Faith Estimate’ explaining how much your medical care may cost. Under the law, health care providers need to give patients who do not have insurance, or who are not using insurance, an estimate of the cost 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. This includes related costs like medical tests, drugs, equipment, and hospital fees.
  • Your health care provider must give you a ‘Good Faith Estimate’ in writing for scheduled services within designated timeframes. You can also ask your health care provider for a ‘Good Faith Estimate’ before you schedule an item or service.
  • A ‘Good Faith Estimate’ of your care will depend on your unique needs and circumstance. As you work with your provider, together you may determine that more, or fewer sessions are needed.
  • A ‘Good Faith Estimate’ is not a contract and you are under no obligation to accept treatment. You may disagree with recommendations or discontinue treatment at any time.
  • If you receive a bill that is at least $400 more than your ‘Good Faith Estimate’, you can dispute the bill without negatively impacting your care.

For questions or more information about your right to a Good Faith Estimate, or to start a dispute, you can visit www.cms.gov/nosurprises or call 1-800-985-3059.

For more information, please contact:
Emily Lewis | Blackwater Counseling Office Manager