Good Faith Estimate (No Surprises Act)

You have the right to receive a Good Faith Estimate (GFE) of the expected charges for your medical care if you don’t have insurance or aren’t using insurance.

Your rights

• You can request a GFE for any non-emergency item or service.
  
• Your provider must give you a written GFE at least 1 business day before your appointment if you schedule in advance.
  
• You may also ask for a GFE before scheduling.
  
• Your GFE should include related costs (for example, tests, prescriptions, equipment, or facility fees, when applicable).
  
• If your bill is at least $400 more than your GFE, you can dispute the bill.
  
• Keep a copy (or photo) of your GFE for your records.
  

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises. If you need help with a GFE from Hazelwood Healthcare, please contact our front desk during business hours.