No Surprises Act and Good Faith Estimates

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.
The Good Faith Estimate does not include any unknown or unexpected costs that may arise during
treatment.

You could be charged more if complications or special circumstances occur. If this happens,
and your bill is $400 or more for any provider or facility than your Good Faith Estimate for that provider
or facility, federal law allows you to dispute the bill.

The Good Faith Estimate is not a contract and does not require the uninsured (or self-pay) individual to
obtain the items or services from any of the providers or facilities identified in the Good Faith Estimate.
If you are billed for more than this Good Faith Estimate, you may have the right to
dispute the bill.

You may contact the health care provider or facility listed to let them know the billed charges are higher
than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate,
ask to negotiate the bill, or ask if there is financial assistance available.

You may also start a dispute resolution process with the U.S. Department of Health and Human
Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process
within 120 calendar days (about 4 months) of the date on the original bill.

If you dispute your bill, the provider or facility cannot move the bill for the disputed item or service into
collection or threaten to do so, or if the bill has already moved into collection, the provider or facility has
to cease collection efforts. The provider or facility must also suspend the accrual of any late fees on
unpaid bill amounts until after the dispute resolution process has concluded. The provider or facility
cannot take or threaten to take any retributive action against you for disputing your bill.

When there is a change to the fees for healthcare services, a new updated good faith estimate will be provided.

Find out more: Section 2799B-6 of the Public Health Service Act www.cms.gov/nosurprises