Good Faith Estimate

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• If you don't have insurance or chose not to use insurance, you have the right to receive a “Good Faith Estimate” explaining how much your any non-emergency items or services will cost. This is called a Good Faith Estimate (GFE)

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• Make sure your health care provider gives you a GFE in writing at least 1 business day before your medical service or item, if you do not plan to submit your receipts (or “super bill”) to your insurance company for reimbursement.

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• You can ask for a Good Faith Estimate before you schedule a service.

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

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• Make sure to save a copy or picture of your Good Faith Estimate.

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• For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call this office (or your provider, if different) after you have scheduled an appointment or before your next scheduled appointment.