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

Good Faith Estimate (GFE) Disclosure

You have the right to get a Good Faith Estimate that explains how much your medical care will cost.

• If you don’t have insurance or aren’t using insurance, your healthcare provider must give you an estimate of the costs for medical services or items.

• You can get a Good Faith Estimate for the total expected cost of any non-emergency service. This includes things like medical tests, prescriptions, equipment, or hospital fees.

• Ask your provider for the estimate at least one business day before your service. You can also ask any other provider for an estimate before scheduling.

• If you get a bill that is $400 or more higher than your estimate, you can dispute the bill.

• Keep a copy or take a picture of your Good Faith Estimate.

For more information, visit www.cms.gov/nosurprises or call 800-985-3059.

Self-Pay Rates (Not for FL Medicaid/Medicare patients)

• One-time Evaluation (no follow-up): $199

• Evaluation (EVAL): $149

• Monthly subscription (includes evaluation first month + 2-week follow-up first month): $149