You have the right to receive a “Good Faith Estimate” explaining how much your exam/service will cost.

Under the No Surprise Act of 2021 uninsured or self-pay patients, including insured patients who do not seek to make a claim for the exam/service to their health plan, have the right to receive a Good Faith Estimate for the total expected cost of exams/services upon request or when scheduling exams/services.

• If you schedule an exam/service at least 3 business days in advance, we will provide a Good Faith Estimate in writing within 1 business day of scheduling.
• If you schedule an exam/service at least 10 business days in advance, we will provide a Good Faith Estimate in writing within 3 business days of scheduling.
• You can also request a Good Faith Estimate before you schedule an exam/service.
• If you are self-pay or insured but do not want to make an insurance claim for the exam/service you may request a Good Faith Estimate.
• If you receive a bill that is at least $400 more than your Good Faith Estimate from a provider or facility, you have the right to dispute the bill via the Dispute Resolution Process.

Save a copy of your Good Faith Estimate and the bill needed to start the Dispute Process.

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.