You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.   Under state and federal law, a patient may ask a health care provider or facility for a Good Faith Estimate of the price they will be charged for nonemergency health care, including costs such as medical tests, prescription drugs, equipment, and hospital fees. The Good Faith Estimate will be in writing and provided within the timeframes stated below: 

  • Any patient may request a Good Faith Estimate of expected charges for nonemergency health care services. When requested, you will receive a copy of this Good Faith Estimate within 3 business days of the request (when uninsured or self-pay) and 5 business days (when insured). 
  • Uninsured Patients. Federal law requires health care providers to provide a Good Faith Estimate in advance of scheduling or upon request if you are uninsured or self-pay (not using your insurance to pay for the item or service). 

Good Faith Estimates will be provided within 3 business days of scheduling nonemergency health care services or within 1 business day if nonemergency health care services are scheduled to be performed within 3 business days. You may ask for a Good Faith Estimate before scheduling an item or service. Uninsured or self-pay patients may dispute the actual charges if they exceed the Good Faith Estimate by at least $400.00. 

TO REQUEST AN ESTIMATE, please call our office at 317-776-7028.  For questions about the Good Faith Estimate, visit www.cms.gov/nosurprises/consumers or call 1-800-985-3059.