Your right to a Good Faith Estimate
If you don't have insurance, or you're paying privately, you have the right to know what your care will cost — in writing, up front.
Under the No Surprises Act, health care providers must give people who don't have insurance, or who aren't using insurance, an estimate of the expected charges for medical items and services. This is called a “Good Faith Estimate.”
- 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 visits, equipment, and supplies.
- You can ask A&Z Health Services, Inc., or any provider you choose, for a Good Faith Estimate in writing before you schedule a service. If you schedule a service at least 3 business days in advance, we will give you a Good Faith Estimate in writing within 1 business day.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Keep a copy or a picture of your Good Faith Estimate.
To ask for a Good Faith Estimate, call us at (813) 400-0324. We're glad to walk you through it.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
This notice applies to uninsured and self-pay (private-pay) patients. Care covered by Medicare or Medicaid is billed to your plan and is handled separately.