Your Right to Receive
A Good Faith Estimate

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

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.

The Good Faith Estimate is not a contract and it does not require you to obtain the items or services.

The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, and your bill per session is $400 or more for any provider than your Good Faith Estimate for that provider, federal law allows you to dispute the bill.

For questions or more information about your right to a Good Faith Estimate, Visit: www.cms.gov/nosuprises