Good Faith Estimate

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 bill for medical
items and services.

  • 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.
  • 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.
  • 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 or call Evoke's Compliance Department at 303-475-6252.

To Print or Download a copy of this Good Faith Estimate notice, click Here!