Standard Notice: “Right to Receive a Good Faith Estimate of Expected Charges” Under the No Surprises Act 

Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good  Faith Estimate” of expected charges.  

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. 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 expected charges for medical items/services, including psychotherapy services. 

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services, including psychotherapy 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 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or 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 .