Good Faith Estimate

The NO SURPRISES ACT and GOOD FAITH ESTIMATES (GFE)

No Surprises Act Overview

Under the No Surprises Act (H.R. 133 - effective January 1, 2022), health care providers are required to provide clients or patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services. This Good Faith Estimate (GFE) shows the costs of items and services you can reasonably expect for your health care needs. You have the right to receive a GFE for the total expected cost of any non-emergency items or services. The GFE does not include any unknown or unexpected costs that may arise during treatment. You may experience additional charges if complications or exceptional circumstances occur.

*Note: A Good Faith Estimate is for your awareness only and does not require immediate financial commitment or payment. 

Your Rights Under the No Surprises Act

If you receive a bill at least $400 more than your GFE, you may dispute or appeal the bill. You may contact the health care provider or facility listed to let them know the billed charges are higher than the GFE. You may ask them to update the bill to match the GFE, negotiate the bill, or ask if financial assistance is available. 

Additional Support and Considerations
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059.

Please note the hourly rate is clearly documented in my Practice Policies and is applicable to the GFE.