No Surprises Act Notice

For Patients

Effective January 1, 2022, uninsured or self-pay patients have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost at our health centers.

Visit cms.gov/nosurprises Call 1-800-985-3059

Your Right to a Good Faith Estimate

Under the law, health care providers need to give uninsured (patients who do not have insurance) or self-pay (patients who are not submitting the claim to their health insurance carrier) an estimate of the bill for medical services or items.

  • Total Expected Cost

    You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services or items. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

  • Get It in Writing

    Ensure your health care provider gives you a Good Faith Estimate in writing for scheduled services within the designated time-frames. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.

  • Disputing a Bill

    If you receive a bill that is at least $400 more than the Good Faith Estimate, you can dispute the bill.

  • Keep a Copy

    Make sure to save a copy of the Good Faith Estimate for your records.

Questions?

If you have additional questions, please visit www.cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059 between 8 AM and 8 PM EST.

No insurance? You can still get care. Ask about our sliding fee discount program. It lowers your cost based on your household size and income.

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