Good Faith Estimate

You have a right to receive a "Good Faith Estimate" explaining how much your medical care will cost. Under the law, healthcare providers need to give patients who do not have insurance or who are not using insurance an estimate of the bill for medical services. 

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

• Make sure your healthcare provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service. 

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

• Make sure you have a copy or picture of your Good Faith Estimate. 

• As mentioned in the informed consent, you have the right to decide at any time not to receive therapy from me. You have the right to end therapy at any time without any moral, legal, or financial obligations other than those already accrued. 

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