Good Faith Estimate Notice (No Surprises Act)

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 expected charges for medical services, including psychotherapy services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• You can ask for a Good Faith Estimate before you schedule a service or at any time.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.