Good Faith Estimate Notice

for clients who don’t have insurance or who are not using insurance

If you don’t have insurance or you are not using insurance, 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 clients who don’t have insurance or who are not using insurance an estimate of the bill for their health care.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency health care, including psychotherapy services.
• Health care providers give you a Good Faith Estimate in writing at least 1 business day before a scheduled health care service. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a 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.