Good Faith Estimate

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

Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage (“Uninsured/Self-Pay Patients”) an estimate of their bill for health care items and services before those items or services are provided.

• If you are an Uninsured or Self-Pay Patient, you have the right to receive a Good Faith Estimate for the total expected cost of any healthcare items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• If you schedule a healthcare item or service at least three business days in advance, make sure your healthcare provider or facility gives you a Good Faith Estimate in writing within one business day after scheduling. If you schedule a healthcare item or service at least ten business days in advance, ensure your healthcare provider or facility gives you a Good Faith Estimate in writing within three business days after scheduling. You can also ask any healthcare provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, ensure the health care provider or facility gives you a Good Faith Estimate in writing within three business days after you ask. Federal law allows you to dispute the bill if your expected costs are $400 or more for any provider than your GFE for that provider.
• This GFE does not include any unknown or unexpected costs that may arise during treatment. Unique to Dermatology, you may schedule your appointment for a particular reason. During your visit, you or the provider may identify other areas of concern. The provider may perform unexpected procedures not contemplated when this GFE was created (such as a biopsy which would also result in unforeseen charges for pathology services). You could be charged more if complications or circumstances previously described occurring.

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