Your Right to a Good Faith Estimate

You have the right to receive a Good Faith Estimate explaining how much your health care will cost. Under federal law (No Surprises Act), health care providers and facilities must give patients who are uninsured or who are not using insurance for a service (self-pay) an estimate of expected charges for non-emergency items and services.

A Good Faith Estimate is not a bill — it’s an estimate based on what is known at the time.

Who Can Request a Good Faith Estimate?

• Uninsured patients (not enrolled in health insurance coverage).
• Self-pay patients, including patients who have insurance but choose not to have a claim submitted for the scheduled item or service.

When Will You Receive It?

• If you schedule care 3–9 business days in advance, you will receive the estimate within 1 business day.
• If you schedule care 10 or more business days in advance, you will receive the estimate within 3 business days.
• If you schedule care 0–2 business days in advance, you are not entitled to a Good Faith Estimate under the federal timeframe rules, but you may still request cost information.
• You can request a Good Faith Estimate before scheduling care; we must provide it within 3 business days.

Business days exclude weekends and federal holidays.

If Your Bill Is Higher Than the Estimate

• If you receive a bill that is at least $400 more than your Good Faith Estimate for any provider or facility, you can dispute the bill through the federal Patient–Provider Dispute Resolution (PPDR) process.
• Save a copy (paper or electronic) of your Good Faith Estimate and your bill.

Requesting a Good Faith Estimate from Elite Performance Institute

To request a Good Faith Estimate before scheduling care, please call our office and we will provide one upon request.

Questions or More Information

• Visit: www.cms.gov/nosurprises/consumers
• Email: FederalPPDRQuestions@cms.hhs.gov
• Call: 1-800-985-3059