No Surprises Act

Your right to a Good Faith Estimate

Under the No Surprises Act, you have the right to receive a Good Faith Estimate of expected charges if you are uninsured or choose not to use (or do not have) insurance for your care. This includes services such as psychiatric evaluations, medication management, and supportive therapy.

What the estimate includes

• An estimate of the total expected cost of any non-emergency items or services;
• Itemized expected charges for each service, where available; and
• A written estimate you can keep for your records.

How and when you get one

You have the right to a Good Faith Estimate for the total expected cost of any non-emergency services. Make sure your health care provider gives you one in writing at least one business day before your service. You can also ask for one before you schedule. If you schedule at least three business days in advance, we will provide the estimate within the timeframes required by law.

If you are billed more than your estimate

If you receive a bill that is at least $400 more than your Good Faith Estimate for any provider or facility, you may be able to dispute the bill through the patient-provider dispute resolution process, generally within 120 calendar days of the date on the bill. Keep a copy of your Good Faith Estimate.

Learn more

For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises or call 1-800-985-3059. To request an estimate from the practice, contact us at 252-381-3152 or through the secure patient portal.