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Standard Notice: “Right to Receive a Good Faith Estimate of Expected Charges” Under the No Surprises Act

Beginning January 1, 2022: If you’re uninsured or you pay for health care bills yourself ("self-pay"; you don’t have your claims submitted to your health insurance plan), providers must provide you with an estimate of expected charges before you receive an item or service.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

• • Make sure your health or mental health care 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 or mental 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 the bill.

  • 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 HHS at (800) 368-1019.