Your Right to a Good Faith Estimate

You have the right to receive a Good Faith Estimate explaining how much your medical care is expected to cost.

Federal law generally requires health care providers to give patients who are uninsured or self-pay as defined by federal law a written estimate of expected charges for scheduled non-emergency items and services.

When you receive it

When you schedule care 3 to 9 business days in advance, the Good Faith Estimate generally must be provided within 1 business day after scheduling.

When you schedule care at least 10 business days in advance, the Good Faith Estimate generally must be provided within 3 business days after scheduling.

You may also request a Good Faith Estimate before scheduling care. When you request one, it generally must be provided within 3 business days.

You may request a Good Faith Estimate before deciding whether to schedule care.

What it is

A Good Faith Estimate is not a bill and does not require you to receive the service.

Your estimate will describe the items and services that Eclosion reasonably expects to provide and the expected charges based on the information available when the estimate is prepared.

Services that are separately scheduled or provided by another independent provider may require a separate Good Faith Estimate from that provider.

Enrollment in Medicare, Medicaid, TRICARE, Veterans Affairs health care, or another federal health care program may be subject to different rules for this specific federal Good Faith Estimate requirement.

If your bill is higher than your estimate

If you receive a bill from a provider that is at least $400 more than the amount that provider listed on your Good Faith Estimate, you may be eligible to use the federal patient-provider dispute-resolution process.

Keep a copy of your Good Faith Estimate so that you can compare it with any bill you receive.

Learn more

To learn more about Good Faith Estimates or the federal dispute process, visit www.cms.gov/nosurprises or call 1-800-985-3059.