Good Faith Estimate

 

Right to Receive a Good Faith Estimate

Pursuant to the federal No Surprises Act, patients who are uninsured or who elect not to use their health insurance coverage have the right to receive a written Good Faith Estimate (“GFE”) of the expected charges for medical items and services.

This estimate is intended to provide transparency regarding anticipated health care costs prior to the delivery of non-emergency services.

 

Scope of the Good Faith Estimate

The Good Faith Estimate will include the total expected charges for non-emergency items and services reasonably anticipated at the time the estimate is issued. This may include, but is not limited to:

  • Professional fees

  • Facility fees

  • Diagnostic testing

  • Durable medical equipment

  • Prescription medications

  • Any other related services reasonably expected to be provided

A written Good Faith Estimate will be provided no later than one (1) business day prior to the scheduled service or item, as required by applicable law. 

Patients may also request a Good Faith Estimate prior to scheduling services.

 

Changes in Services or Charges

The Good Faith Estimate is based on information known at the time it is issued. Circumstances may change, and additional services may be recommended during the course of treatment that were not reasonably anticipated at the time the estimate was prepared.

Accordingly:

  • The actual items, services, or charges may differ from those included in the Good Faith Estimate.

  • Additional services that are medically necessary but not reflected in the original estimate may be scheduled or billed separately.

The Good Faith Estimate is not a guarantee of final charges.

 

Patient-Provider Dispute Resolution Process

If the total billed charges are at least $400 or more above the total amount listed in the Good Faith Estimate, the patient has the right to initiate a dispute through the federal patient-provider dispute resolution process.

Initiating a dispute will not adversely affect the quality of care provided.

Patients are encouraged to retain a copy of their Good Faith Estimate for their records.

 

No Contractual Obligation

The Good Faith Estimate is provided for informational purposes only and does not constitute a contract. It does not require the patient to obtain any listed services from the identified provider or facility.

 

Additional Information

For additional information regarding your rights under the No Surprises Act, please visit: https://www.cms.gov/nosurprises

You may also contact our office directly at: Phone: 713-714-6404