Angela D. Mathew, LMFT, MA

Licensed Marriage and Family Therapist


DBA:  Angela Mathew Counseling, PLLC


No Surprises Act


Good Faith Estimate


You have the right to receive a “Good Faith Estimate”

explaining how much your health care will cost

Under the law, health care providers need to give patients who don’t have certain types of

health care coverage or who are not using certain types of health care coverage an

estimate of their bill for health care items and services before those items or services are

provided.

• You have the right to receive a Good Faith Estimate for the total expected cost of

any health care items or services upon request or when scheduling such items or

services. This includes related costs like medical tests, prescription drugs,

equipment, and hospital fees.

• If you schedule a health care item or service at least 3 business days in advance,

make sure your health care provider or facility gives you a Good Faith Estimate in

writing within 1 business day after scheduling. If you schedule a health care item or

service at least 10 business days in advance, make sure your health care provider

or facility gives you a Good Faith Estimate in writing within 3 business days after

scheduling. You can also ask any health care provider or facility for a Good Faith

Estimate before you schedule an item or service. If you do, make sure the health

care provider or facility gives you a Good Faith Estimate in writing within 3

business days after you ask.

• If you receive a bill that is at least $400 more for any provider or facility than your

Good Faith Estimate from that provider or facility, you can dispute the bill.

• Make sure to save a copy or picture of your Good Faith Estimate and the bill.


For questions or more information about your right to a Good Faith Estimate, visit

www.cms.gov/nosurprises/consumers, email [email protected], or call 1-

800-985-3059.