Good Faith Estimate

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

As of January 1, 2022, all 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 are entitled to a Good Faith Estimate in writing at least 1 business day before your medical service or item and/or upon request. 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.

The Good Faith Estimate shows the cost of items and services that are reasonably expected for your healthcare needs and treatment. While it is not possible for a dietitian to know, in advance, how many sessions may be necessary or appropriate for a given person, this form provides an estimate of the cost of services provided. Your total cost of services will depend upon the number of nutrition sessions you attend, your individual circumstances, and the type and amount of services that are provided to you. This Good Faith Estimate does not include unexpected costs that could arise during treatment.  Unexpected costs could include fees for outside referrals, cancellation and/or no-show fees, fees for lab work, etc.

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.