What is the No Surprise Act/Good Faith Estimate?

Standard Notice: Right to Receive a Good Faith Estimate of Expected Charges Under the No Surprises Act

Under the No Surprises Act (H.R. 133), healthcare providers must give clients or patients who do not have insurance or who choose not to use insurance an estimate of the bill for medical items and services.

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes (when applicable) related costs like medical tests, prescription drugs, equipment, and hospital fees.

The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.

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

Keep a copy of your Good Faith Estimate in a safe place or take pictures of it.

You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute within 120 calendar days of the date on the original bill.

This serves as our public disclosure of the Good Faith Estimate.

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