Notice regarding Good Faith Estimates

Under the “No Surprises Act,” a federal law that took effect on January 1, 2022, you have the
right to receive a Good Faith Estimate explaining how much your medical care will cost. Health
care providers (including psychotherapists and psychologists) are required to give patients who
don’t have insurance or who are not using insurance an estimate of the bill for medical items and

• 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.

• Make sure your 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 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 or call the CMS Help Desk at 1-800-985-3059.