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Good Faith Estimate

According to the recent law passed, the “No Surprises Act” (H.R.133, effective January 1, 2022), healthcare providers are required to provide patients (who do not have insurance or who are have chosen to not use insurance) with a Good Faith Estimate of the cost for their medical items or services.



You have the right to be provided a “Good Faith Estimate” that explains the costs associated with your medical care.  The Good Faith Estimate will show the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate will be based on information known at the time the estimate was created.

The Good Faith Estimate will 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.

Under this law,

• You have the right to be provided with a Good Faith Estimate that reviews the expected total cost of non-emergency items or services. This includes costs such as prescription drugs, medical tests, equipment, as well as hospital fees.

• Your healthcare provider is to share a Good Faith Estimate with you in writing at least 1 business day before your medical service. In addition, you have the right to ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate prior to your scheduling an item or service.

• Should you receive a bill that is at least $400 more than the Good Faith Estimate, you have the right to dispute the bill.

• Please be sure to save a copy or picture of your Good Faith Estimate.

If you have any questions you may contact your healthcare provider for any questions at . If you continue to have questions, you may get further information about your rights regarding the Good Faith Estimate by visiting or calling (800) 368-1019.

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