Your Right to a Good Faith Estimate

Under the No Surprises Act, health care providers are required to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

What is a Good Faith Estimate?

You have the right to receive a Good Faith Estimate (GFE) for the total expected cost of any non-emergency items or services. This includes related costs like intake fees, testing hours, and feedback sessions associated with your evaluation.

Key Details Regarding Your Estimate:

• Timing: Lumina will provide you with a written Good Faith Estimate at least 1 business day before your scheduled assessment. You can also ask for a GFE before you schedule an appointment.

• Record Keeping: If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Be sure to save a copy or picture of your GFE for your records.

• Updates: A Good Faith Estimate is not a contract. It is an estimate based on the clinical information available at the time. If the scope of the assessment changes significantly during our work together, I will provide an updated estimate.

Questions or Disputes?

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprisesor call the No Surprises Help Desk at 1-800-985-3059.