OMB Control #: 0938-1401
Expiration Date: 03/31/2022
You have the right to receive a “Good Faith Estimate” (GFE) explaining how much your medical care will cost.
Under the law, health care providers need to give patients who do not 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 GFE for the total expected cost of any services you are paying for out-of-pocket
- Make sure your health care provider gives you the GFE in writing at least 1 business day before your medical service. You can also ask your provider, or any provider you choose, for a GFE before you schedule a service.
- If you receive a bill that is at least $400.00 more than your GFE, you can dispute the bill.
- Make sure you save a copy or picture of your Good Faith Estimate.
For questions, contact Julie Whitmore, Office Manager at 248-203-9107. You can also visit www.cms.gov/nosurprises.