Know what to expect with a Good Faith Estimate.

Nobody likes surprises when they get a bill. A Good Faith Estimate tells you how much you can expect to pay for your healthcare – before you have to pay.

Who should get a Good Faith Estimate?

By law:

• People who don’t have insurance
• People who have insurance and choose not to use it (self-pay)

It’s your right. It’s our responsibility.

You can ask for a Good Faith Estimate of the total expected cost of any healthcare services and items when you make an appointment. You can also ask at any time between when you make your appointment and when you get those services and items.

Your Good Faith Estimate will include related costs, like:

• Medical tests
• Prescription drugs
• Medical equipment
• Hospital fees

Getting a Good Faith Estimate when you make an appointment at least three (3) days ahead.

If you make an appointment for a healthcare item or service at least three (3) business days ahead, we must give you a Good Faith Estimate in writing within one (1) business day after you make that appointment.

Example
You call us on a Monday to make an appointment. Your appointment is three business days later on Thursday.

This means you should get a Good Faith Estimate before Wednesday.

Getting a Good Faith Estimate when you make an appointment at least ten (10) days ahead.

If you make an appointment for a health care item or service at least ten (10) business days ahead, we must give you a Good Faith Estimate in writing within three (3) business days after you make that appointment.

Example 2
You call us on a Monday to make an appointment. Let’s say it’s the first of the month. Your appointment is ten business days later on the 15^th.

This means you should get a Good Faith Estimate before Friday the 5^th.

Getting a Good Faith Estimate before you make an appointment.

You can also ask us for a Good Faith Estimate before you make an appointment for an item or service. If you do, we must give you a Good Faith Estimate in writing within three (3) business days.

Example 3
You ask us for a Good Faith Estimate on a Monday. This time, you do not make an appointment.

This means you should get a Good Faith Estimate before Friday.

A Good Faith Estimate can protect you from paying more for your care.

If you get a bill from us that is $400 or more than the amount on your Good Faith Estimate from us for those services or items, you can dispute the bill.

How to get a Good Faith Estimate from Equitas Health

During an appointment
If you and your provider discuss a healthcare item or service that you are getting – or might get – in the future, you can ask them for a Good Faith Estimate.

When you make an appointment
You can ask the Equitas Health staff person who schedules your appointment for a Good Faith Estimate of the healthcare services and items for that appointment.

After you have made an appointment
You can call (833) 378-4827 and press 5 to talk to our Billing Department. You can also send them an email at billing@equitashealth.com.

Remember

If you are using insurance to pay for your care at Equitas Health, and we are an in-network provider for your plan, you do not need a Good Faith Estimate.

Questions?

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.

To download a flyer about the No Surprises Act and Good Faith Estimates, follow these links:
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