Your right to a Good Faith Estimate

If you pay for your own care, federal law gives you the right to a written estimate of expected charges before your care. This is the federal notice, in full:

You can ask before you schedule anything. Because you pay for your own care, you also receive one in writing when a lab panel, a provider visit or a medication supply is scheduled.

Your coordinator already explains each cost before you pay. The Good Faith Estimate puts the expected charges in writing, from the medical practice that provides your care, our affiliated medical practices.

The timing depends on when you schedule. These are the federal rules as CMS explains them:

• If you ask before scheduling, you receive the estimate within 3 business days.
• If you schedule 3 to 9 business days ahead, you receive it within 1 business day.
• If you schedule 10 or more business days ahead, you receive it within 3 business days.
• If you schedule 0 to 2 business days ahead, the law does not require an estimate, but you can still ask your coordinator for the costs in writing.

An estimate can also be discussed with you by phone, and you can ask for a new copy at any time. The federal notice above is posted in our offices, and you can ask for it, or for your estimate, by phone or in another format.

The estimate lists the expected charges for the items and services you have scheduled or asked about, each on its own line. For care with us, that means the parts of cost that apply to you at that point.

• Lab work: the panel your provider or coordinator has ordered.
• Provider fee: your provider's visits and reviews for a set period.
• Medication supply: only if a provider has prescribed treatment, for the supply length you are considering.

The estimate also gives the name, National Provider Identifier and Tax Identification Number of each provider or facility, the service and diagnosis codes where they are known, and any items or services that are billed separately. Each estimate covers one provider or facility. A lab or pharmacy that bills you directly may give you its own estimate. An estimate is not a contract and does not mean that a provider will prescribe treatment.

If a bill from a provider or facility is higher than its Good Faith Estimate by at least the amount in the federal notice above, you can dispute the bill through the federal patient-provider dispute resolution process. You must start the dispute process within 120 calendar days of the date on the original bill. You must start the dispute within 120 calendar days of the date on the original bill. Keep a copy of your estimate: you cannot dispute a bill without one.

Contact us first and we will review the bill with you. For the dispute process, or to file a complaint if you did not get an estimate you should have received, visit www.cms.gov/nosurprises or call 1-800-985-3059.

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