Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

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 such as diagnostic imaging,
radiation, infusion, prescription drugs, and surgeries.
It is your right to receive a Good Faith Estimate from your provider, in writing, at least 1
business day before your medical service or item. You can also request health care
providers provide a Good Faith Estimate prior to you scheduling services.
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.
Providers cannot balance bill a patient that is out of network unless patient was notified
prior to services and signed an agreed upon consent to waive protections.
Any State laws supersede Federal protections against balance billing.

Listed below is contact information for individuals who feel a facility or provider has violated
the state or federal requirements against balance billing.

For questions or more information about your right to a Good Faith Estimate, visit:

Department of Health and Human Services: www.cms.gov/nosurprises or 877-696-6775

Oklahoma: https://www.oid.ok.gov/ or 918-295-3700

*If your state does not have guidelines relating to No Surprises Billing, contact the Department of Health and Human Services.