ALISON NEWCOMER, PhD · NOTICE TO PATIENTS

Your Right to Receive a Good Faith Estimate

Notice Under the No Surprises Act

You have the right to receive a Good Faith Estimate explaining how much your health care will cost.

Under federal law, health care providers are required to provide patients who do not have insurance, or who are not using insurance to pay for their care, with an estimate of the expected charges for health care items and services.

You have the right to receive a Good Faith Estimate for the expected cost of your care when you schedule services or upon request.

If you schedule a service at least 3 business days in advance, you are generally entitled to receive a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule at least 10 business days in advance, the estimate generally must be provided within 3 business days after scheduling. You may also request a Good Faith Estimate before scheduling services; in that case, it generally must be provided within 3 business days of your request.

The Good Faith Estimate will include the expected charges for the services reasonably expected to be provided by this practice. The estimate is not a bill, and actual charges may differ if the scope or frequency of services changes.

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

Please keep a copy of your Good Faith Estimate for your records.

For more information about Good Faith Estimates and your rights under federal law, visit the Centers for Medicare & Medicaid Services.

Learn more about Good Faith Estimates and your rights →

No Surprises Help Desk: 1-800-985-3059