GOOD FAITH ESTIMATE NOTICE

YOU HAVE THE RIGHT TO RECEIVE A "GOOD FAITH ESTIMATE" EXPLAINING HOW MUCH YOUR MEDICAL CARE WILL COST

Under the law (“The No Surprises Act”), healthcare providers must provide patients who don't have insurance or are not using insurance with an estimate of the bill for medical items and services. You will receive this notice if you don’t have insurance or if your provider is out-of-network. Please note your right to the following:

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. It is an estimate only. It does not include any information about your health plan, such as what it may cover, reimbursement, or if the amount will count towards your deductible or out-of-pocket limit.

• Make sure your healthcare provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your healthcare 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 http://www.cms.gov/nosurprises or call 800-985-3059.