Good Faith Estimate

Your right to a Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers must give patients who don’t have insurance, or who are not using insurance, an estimate of the expected charges for medical services.

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

How to get one

• You can ask Quality Primary Care Associates, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you schedule a service at least three business days in advance, we will provide your Good Faith Estimate in writing within one business day. If you schedule at least ten business days in advance, you will receive it within three business days.
• You may also request a Good Faith Estimate at any time, and we will provide one within three business days.

If your bill is higher than your estimate

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill through the federal patient-provider dispute resolution process. You must start the dispute process within 120 days of the date on your original bill.

Questions

To request a Good Faith Estimate, or if you have questions about an estimate you received from us, please call our team at 301-762-7723. For more information about your rights under the No Surprises Act, or to learn about the dispute process, visit www.cms.gov/nosurprises or call 1-800-985-3059.