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What is a Good Faith Estimate?

A Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created. The Good Faith estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to appeal the bill.

What do I need for a Good Faith Estimate?

If you have not completed a financial assessment within the last 12 months, please bring proof of income to be assessed for possible discounts during your visit. Any discounts included in this estimate are based on your most recent assessment on file. For patients receiving an estimate of $0.00, you MUST bring proof of income to be reassessed at the time of visit in order to keep your discount status. Acceptable proof includes, but is not limited to:

  • Pay stubs
  • Bank statement showing deposits from employer
  • Letter from employer 
  • W-2
  • Income tax returns 
  • FAFSA financial form 

What if my bill is higher than my Good Faith Estimate?

If your bill is higher than your Good Faith Estimate, you have the right to appeal. This right is given to you under federal law.


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