Right to Receive a Good Faith Estimate

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

Under the law, health care providers need to give patients who do not have insurance or who choose not to use their insurance (self-pay) an estimate of their bill for health care items and services.

You have the right to receive a Good Faith Estimate of expected medical costs of any non-emergency items or services if you:

• do not have health insurance;
• choose to not use your health insurance; or
• are receiving care from an out-of-network healthcare provider and do not have out-of-network health insurance benefits.

The good faith estimate includes related costs like medical tests, prescription drugs, equipment, office visit charges, and hospital fees.

Timing Requirements:

• If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling.
• You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
• 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, submit an email to GFEQuestions@swgeneral.com or visit www.cms.gov/nosurprises or call the Center for Medicare & Medicaid No Surprises Helpdesk at 1-800-985-3059.