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.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. 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.
• Any patient may request an estimate of the expected charges for non-emergency health care services that have been ordered, scheduled, or referred and health care providers and facilities are required provide you with an estimate of the expected bill for medical items and services within 5 business days of the request.
• 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.

Click here for additional information related to your rights and protections against surprise medical bills.

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

If you would like to receive an estimate, please contact our Billing Department at 812-532-3493.  Please be prepared to provide client name, date of birth, location of appointment, and specific service so that we are best able to estimate cost.