Good Faith Estimate Notice

If you are uninsured or self-pay, you have the right to receive a Good Faith Estimate explaining how much your dental care will cost.

Under the law, healthcare providers, including dental practices, must give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical and dental 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 like exams, x-rays, and treatments.
• Make sure to ask your dental provider for a Good Faith Estimate in writing at least 1 business day before your appointment.
• You can also ask for a Good Faith Estimate before you schedule a service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call our office.