Good Faith Estimate

Last updated: Draft — pending review

Note for the practice: This summary reflects the federal No Surprises Act notice. Please confirm the current required wording and figures with a qualified healthcare attorney before launch.

You have the right to a Good Faith Estimate

Under the law, health care providers must give patients who don't have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychiatric and mental health care.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services, including related costs like medications and follow-up care.
• You can ask for a Good Faith Estimate before you schedule a service, and you have the right to one in writing at least one business day before your appointment.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you may be able to dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

How to request one

To request a Good Faith Estimate, contact us at info@ujinnerpeacehealthcareservices.com or (805) 876-4522.

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