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PATIENTS WHO DO NOT HAVE INSURANCE OR WHO ARE NOT USING INSURANCE:

  You have the right to receive a 'Good Faith Estimate' explaining how much your healthcare will cost.

Click on the DOCX image below to download form.

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 healthcare items.

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GOOD FAITH ESTIMATE

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.

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

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

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Make sure to save a copy or picture of your Good Faith Estimate.

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For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call CMS at 1-800-985-3059.

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