Your rights & protections
Good Faith Estimate
Under the federal No Surprises Act, you have the right to know the expected cost of your care before you receive it.
You have the right to receive a Good Faith Estimate explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don't have insurance or who are not using insurance an estimate of the expected charges for medical items and services.
What this means for you
- 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 medical tests, prescription drugs, equipment, and fees.
- You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
Questions?
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
To request a Good Faith Estimate for care at Empower Therapeutics, call us at (907) 743-7820.
This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time it was created and does not include any unknown or unexpected costs that may arise during treatment.
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