Your Right to a
Good Faith Estimate

This page explains a federal patient protection in plain language. It is based on the sample notice published by the Centers for Medicare & Medicaid Services (CMS). It is general information and is not a Good Faith Estimate, a bill, or a quote of Greatfaith's prices.

You have the right to a Good Faith Estimate

Under the federal No Surprises Act, patients who do not have insurance or who are not using insurance to pay (self-pay patients) generally have the right to receive a written Good Faith Estimate of the expected charges for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of non-emergency items or services.
• The estimate can include related costs such as tests, prescription drugs, equipment, and fees.

You can ask for an estimate before scheduling

You can ask any provider for a Good Faith Estimate before you schedule an item or service. If you schedule a non-emergency service, you can also expect to receive a written estimate. In general:

• If you request a Good Faith Estimate, it is generally provided within 3 business days of your request.
• If a service is scheduled at least 3 business days in advance, a written estimate is generally provided within 1 business day of scheduling.
• If a service is scheduled at least 10 business days in advance, a written estimate is generally provided within 3 business days of scheduling.

Make sure your provider gives you a Good Faith Estimate in writing at least 1 business day before your item or service. Keep a copy or a picture of your estimate.

If your bill is higher than your estimate

If you receive a bill that is at least $400 more than your Good Faith Estimate, you may have the right to dispute the bill through the federal patient-provider dispute resolution process.

• You generally must start the dispute process within 120 calendar days of the date on your original bill.
• Starting a dispute will not affect the quality of care you receive.

Important notes

• A Good Faith Estimate is not a contract and does not require you to receive the items or services from Greatfaith.
• This webpage is general information. It does not replace a written Good Faith Estimate, and it does not state that every request falls under the federal process.
• Greatfaith does not list prices on this website. To ask about an estimate, contact the practice using the details below.

Learn more from CMS

For questions or more information about your right to a Good Faith Estimate, visit the official CMS No Surprises resource or call CMS:

• Website: www.cms.gov/nosurprises (opens the official CMS website in a new tab)
• Phone: 1-800-985-3059

Contact Greatfaith

To ask about a Good Faith Estimate, contact Greatfaith Managed Care at (424) 402-0661 or info@greatfaithcare.com. You can also request a visit.