Good Faith Estimate

What is it?

A Good Faith Estimate (GFE) is an estimate provided by a health care provider or facility that outlines the expected costs of medical services or procedures before they are delivered. The estimate is given to patients who are either uninsured or paying out-of-pocket for their health care. The goal of a Good Faith Estimate is to help individuals understand the costs they might incur under the No Surprise Act of 2022.

What is the No Surprise Act?

The No Surprise Act is a federal law that was enacted as part of the Consolidated Appropriations Act of 2021 and took effect on January 1, 2022. Its primary goal is to protect patients from unexpected medical bills, particularly those that arise when they receive care from out-of-network providers or facilities without their knowledge or consent.

Your Rights

You have the right to request a Good Faith Estimate including a detailed list of reasonable expected charges for the services recommended. The estimated costs of therapeutic services are valid from 12 months from the date of the initial document provided. You have the right to request an updated estimate if additional services are added to your plan of care. You are not required to accept this estimate or proceed with scheduling services.

Likewise, you have the right to dispute (appeal) the bill.

You can initiate a dispute resolution process by contacting the U.S. Department of Health and Human Services (HHS):

  • Website: www.cms.gov/nosurprises

  • Phone: 1-800-985-3059

To begin the dispute process, you must:

  • Start the process within 120 calendar days of receiving the bill

  • Include a copy of this Good Faith Estimate and the bill you received

Disclaimers

  • The estimate is based on non-emergency scheduled services and does not include unknown or unexpected costs that may arise during treatment.

  • You may be charged more if complications or special circumstances occur.

  • Due to cancellations, holidays, weather, and/or other events, the total number of services provided across the initial timeframe may be less than your original good faith estimate.