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Good Faith Estimate and No Surprises
Under the No Surprises Act (H.R. 133), effective January 1, 2022, health care providers are required to give clients or patients who do not have insurance or are not using insurance an estimate of the bill for medical items and services.
This Good Faith Estimate, based on information available at the time it is created, shows the cost of items and services reasonably expected for healthcare needs.
Clients have the right to receive a Good Faith Estimate for the total expected cost of non-emergency items and/or services.
The Good Faith Estimate does not include unknown or unexpected costs that might arise during treatment. You might be charged more if there are special circumstances or complications. You may dispute (appeal) the final bill under federal law if that occurs.
You may dispute a bill that is $400 or more than your Good Faith Estimate. You may contact your healthcare provider or facility to inform them that the billed amount is higher than the Good Faith Estimate, and ask them to update the bill to match the Good Faith Estimate, request financial assistance, or ask to negotiate the bill.
You may begin a dispute resolution process with the U.S. Department of Health and Human Services (HHS), so long as it is within 120 calendar days of the date on the original bill. There is an associated fee of $25. If the reviewing agency agrees with your dispute, you are responsible for the price on the Good Faith Estimate. If they agree with the health care provider, you will have to pay the higher amount.
The Good Faith Estimate should be received within the following timeframe:
Within three business days of request of a Good Faith Estimate from an uninsured or self-pay patient
If the service is scheduled at least three days prior to the appointment date, within one business day of scheduling
If the service is scheduled 10 or more business days before the appointment date, within 3 business days after the date of scheduling
Keep a copy of the Good Faith Estimate in a safe place, or take pictures of it.
To learn more about the Good Faith Estimate, or get a form to begin the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059.