You have the right to receive a “Good Faith Estimate” explaining how much your health 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 bill for medical items and services.

If you have changed insurance to a plan where your CHPA provider is out of network, or have decided not to use insurance, please let us know as soon as possible. This will allow us to provide the required GFE.*

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 hospital fees.

Your provider(s) at CHPA can provide a GFE regarding anticipated costs at CHPA.  GFE’s regarding “medical tests, prescription drugs, equipment, and hospital fees” must be obtained from the company providing the service or item.*

Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item.  You can also ask your health care provider, and any other provider you choose for a Good Faith Estimate before you schedule an item or service.

Your CHPA providers require at least two business days’ notice in order to provide a written GFE at least one business day before your appointment.  If your circumstances change at the last minute, we can still provide a GFE but it will be verbal.*

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.

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

​* Indicates information provided by and specific to CHPA

Good Faith Estimate Notice ↗️

Patient Agreement

Privacy Practices

Forms