NO SURPRISES ACT NOTICE
“GOOD FAITH ESTIMATE”
Revised January 1, 2022
• Congressional Act passed and put into effect January 1, 2022 entitles you to receive a “Good Faith Estimate” (GFE) outlining how much your medical bills may be.
• Under the law, health care providers need to give patients who either do not have health insurance or choose not to use their in-network benefits an estimate of the potential charges associated with their care and services.
• You have the right to a GFE for the total expected cost of non-emergent services and fees.
• This GFE should be available to you in writing within designated timeframes before your services are received. You can also request a GFE before you schedule an item or service.
• If your expenses related to received services or items exceeds your GFE, you have the right to dispute the bill. You may contact the health care provider or facility listed to let them know the billed charges are higher than the GFE. You can ask them to update the bill to match the GFE, ask to negotiate the bill, or ask if there is financial assistance available. If you receive a bill that is at least $400 more than your GFE, you can dispute the bill. You must start the dispute process with the U.S. Department of Health and Human Services (HHS) within 120 calendar days of the date on the original bill. If HHS agrees with you, you will pay the price on the Good Faith Estimate. If HHS disagrees with you and agrees with the health care provider, you will have to pay the higher amount. Make sure to save a copy of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit: https://www.cms.gov/nosurprises or call 1-800-985-3059.
