Due to a new federal law, you have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, health care providers are now required to give patients who do not have insurance or who are not submitting their receipts to insurance (either in or out-of-network), a Good Faith Estimate of the bill for medical items and services.
● You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs such as medical tests, prescription drugs, equipment, and hospital fees.
● If you receive a bill that is at least $400 more than your Good Faith Estimate, you may dispute the bill.
● Make sure to save a copy or picture of your Good Faith Estimate.
Disclaimer: The 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. Under federal law you are able you to appeal. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
If you have questions about your bill and/or a Good Faith Estimate, please contact Dorota Mielko, office manager, at email@example.com or (201) 670-6450 ext. 1.