Your rights under the No Surprises Act

Good Faith Estimate notice

Under federal law, health care providers must give patients who don't have insurance — or who choose not to use it — a written estimate of expected charges before services are provided.

You have the right to a Good Faith Estimate

Under Section 2799B-6 of the Public Health Service Act (the "No Surprises Act"), health care providers are required to give clients who are uninsured or who are not using insurance an estimate of the expected charges for medical services, including psychological evaluation and related services.

• You have the right to receive a Good Faith Estimate for the total expected cost of non-emergency services, including psychological testing, feedback, and report preparation.
• You may ask for a Good Faith Estimate before you schedule a service, and you will receive one in writing at least one business day before your service when scheduled at least three business days in advance.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill through a federal patient–provider dispute resolution process.
• Make sure to save a copy or picture of your Good Faith Estimate.

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