Good Faith Estimate Notice

The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive:

• Most emergency services
• Non-emergency services from out-of-network providers at in-network facilities
• Services from out-of-network air ambulance service providers.

It also provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the good faith estimate they get from the provider.

The No Surprises Act grants you the right to receive a “Good Faith Estimate,” which outlines potential costs of your medical care. This transparency is to ensure you’ll never face unexpected charges or “surprises” for services you haven’t explicitly agreed to.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059

To request a Good Faith Estimate from Nutrition By Carrie, ask Carrie Dennett at your next session.

This notice is effective 1/1/22