Good Faith Estimate

Understanding Your Right to Receive a Good Faith Estimate of Expected Charges

 

Under the No Surprises Act, health care providers and health care facilities are required to provide individuals who are not enrolled in any insurance plan and do not have coverage under a Federal health care program (that is, Medicare, Medicaid, or Tricare), or not planning on filing a claim with their plan or coverage, with an estimate of the cost for the services being requested.  This estimate is to be provided both orally and in writing.  It is to represent only an estimate, but one made to the best of the ability of your provider.

 

While it does not have to be exact, the law gives you the authority to contest any bill that is $400 or more higher than the estimate.  If the provider has reason to believe that the estimate is inaccurate, the estimate can be updated but only for future services.  You can refuse to continue to seek care from the provider if an updated estimate of future charges is more than you wish to pay.  There is no requirement that once you start receiving services, you cannot stop.  

 

If the billed charges are higher than the good faith estimate you can ask your provider or facility to update the bill to match the good faith estimate, ask to negotiate the bill, or ask if there is financial assistance available. 

If you get a bill that is at least $400 more for any provider of this facility than the total expected charges for that provider or facility on the good faith estimate, there is a new patient-provider dispute resolution (PPDR) process available to you.  Under the PPDR process you may request a payment review and decision from an independent company certified by HHS.  These companies are referred to as Selected Dispute Resolution (SDR) entities.  The SDR entity will decide what amount you must pay if your bill is at least $400 more for any provider or facility than your good faith estimate from the provider or facility.

 

The good faith estimate does not include services not provided by your provider that you may need, or your provider may recommend. 

 

Please keep a copy of the good faith estimate as you will need it for the above process.

 

For questions or more information related to the Good Faith Estimate, visit www.cms.go/nosurprises or call 800-368-1019.   


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