Legal

Good Faith Estimate

Your right to receive an estimate of what your care will cost.

Awaiting text from the client’s attorney

This page is scaffolded but intentionally unwritten. Legal notices must be drafted or reviewed by the practice’s attorney, not adapted from a template, because they make binding statements about how client information is handled.

Required under the federal No Surprises Act for uninsured and self-pay clients. Much of this notice has standard wording published by CMS, so the attorney should confirm the current text and add the practice's own rates and dispute-resolution contact.

Replace this block with the supplied text. The headings below are the sections a document of this kind usually covers.

Expected sections

  1. 01Your right to a Good Faith Estimate under the No Surprises Act
  2. 02Who is entitled to one: uninsured and self-pay clients
  3. 03What the estimate includes and when it is provided
  4. 04That the estimate is not a contract and does not oblige you to obtain services
  5. 05What to do if the bill is at least $400 more than the estimate
  6. 06How to start a patient–provider dispute resolution process
  7. 07Where to get more information (cms.gov/nosurprises) and the help line number
  8. 08The practice's contact details for questions about an estimate