You have the right to receive a Good Faith Estimate explaining how much your medical care will cost. If you are an uninsured patient or are not using insurance, you have the right to receive a Good Faith Estimate for the total expected cost of any items or services. This includes related costs like medical tests, prescription drugs, and equipment.

If you request a Good Faith Estimate, your health care provider is to provide you with the Good Faith Estimate in writing at least one business day of scheduling your medical service or item. You can also request to receive a Good Faith Estimate prior to scheduling a medical service or item. If you receive a bill that is at least $400.00 more than your Good Faith Estimate, you may dispute the bill. Make sure to save a copy of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, please visit the website https://www.cms.gov/nosurprises
You can also call 1-800-985-3059 or email federalppdrquestions@cms.hhs.gov to request additional information or to ask questions.

Disclaimer: The Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service at the time of scheduling your health care appointment. The estimate is based on information known at the time the estimate was created. You could be charged more if special circumstances occur. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment.

To receive your Good Faith Estimate, please contact your physician's office.