Your right to a Good Faith Estimate

Who it’s for

Patients without insurance, or not using insurance for a service

How to ask

Call (310) 326-2161 or ask at the front desk

Timing

Within 1–3 business days, depending on when you schedule

Cost

No charge for the estimate

You 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 an estimate of their bill for health care items and services before those items or services are provided.

• You have the right to receive a Good Faith Estimate for the total expected cost of any health care 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 health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
• If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.

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.

Source: Centers for Medicare & Medicaid Services standard notice, “Right to Receive a Good Faith Estimate of Expected Charges.”

How to request an estimate from our office

Call us at (310) 326-2161 or ask at the front desk. Tell us which visit, test or treatment you are considering. Estimates apply to self-pay family medicine visits as well as cosmetic treatments that insurance does not cover.

If you have Medicare or Medi-Cal, please let us know — different billing rules may apply.

In other languages

한국어: 보험이 없거나 보험을 사용하지 않는 경우, 진료 전에 예상 비용에 대한 서면 견적(Good Faith Estimate)을 요청할 권리가 있습니다. 문의: (310) 326-2161

日本語：保険をお持ちでない方、または保険を使用されない方は、診療の前に予想費用の書面見積もり（Good Faith Estimate）を請求する権利があります。お問い合わせ：(310) 326-2161

Español: Si no tiene seguro médico o no lo usa para un servicio, tiene derecho a recibir por escrito un “Cálculo de buena fe” de los costos esperados antes de su atención. Llame al (310) 326-2161.