In accordance with the Public Health Services Act, health care providers must furnish a Good Faith Estimate of expected charges, ensuring that uninsured and self-pay individuals have information about health care pricing before receiving care. The purpose of the Good Faith Estimate requirement is to give individuals an opportunity to evaluate their health care options, manage care costs, and prevent surprise billing.

NOTICE: Under the No Surprises Act, you have the right to receive a Good Faith Estimate of expected charges.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency medical and mental health care services. The expected charge for a services is the cash pay rate or the rate established by a provider for an uninsured or self-pay client.

• Make sure your healthcare provider gives you a Good Faith Estimate in writing at least one business day before your medical services 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 www.cms.gov/nosurprises or call 1-800-633-4227.