STANDARD NOTICE
“Right to Receive a Good Faith Estimate of Expected Charges” Under the No Surprises Act
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers must give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items or services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.
This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service. You can also ask your health care provider 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
or call Jill Robinson at (412) 216 – 9895.
“Right to Receive a Good Faith Estimate of Expected Charges” Under the No Surprises Act
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers must give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items or services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.
This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service. You can also ask your health care provider 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
or call Jill Robinson at (412) 216 – 9895.