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

Under the law, health care providers need to give patients who don’t have certain types of health care
coverage or who are not using certain types of health care coverage an estimate of their bill for health
care items and services before those items or services are provided.

• You have the right to receive a Good Faith Estimate for the total expected cost of any health care
items or services upon request or when scheduling such items or services. This includes related costs like
medical tests, prescription drugs, equipment, and hospital fees.

• If you schedule a health care item or service at least 3 business days in advance, make sure your health
care provider or facility gives you a Good Faith Estimate in writing within 1 business day after
scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure
your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days
after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before
you schedule an item or service. If you do, make sure the health care provider or facility gives you a
Good Faith Estimate in writing within 3 business days after you ask.

• If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate
from that provider or facility, you can dispute the bill.

For questions or more information about your right to a Good Faith Estimate, visit
www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.