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Good Faith Estimate Disclosure

Good Faith Estimate Disclousre

For uninsured/self-pay patients:

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Descargo de responsabilidad sobre estimaciones de buena fe - En Español

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.
  • You have the right to receive a Good Faith Estimate for co-provider services and fees when this information is made available to us.This may include professional fees for surgery, anesthesia, or radiology that are not billed by SCL Health. If there is a discrepancy between the estimated amount and the amount billed, please contact the co-provider or service provider for resolution.
  • 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.
  • Upon scheduling your procedure or service, Intermountain Health will send you a Good Faith Estimate in writing.

If you believe you have been incorrectly billed by Intermountain Health, please contact Intermountain Health Customer Service at 1-866-665-2636.

If you believe you have been incorrectly billed by another co-provider included in your Good Faith Estimate, please contact the appropriate co-provider or billing agent.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or contact the No Surprises Helpdesk at 1-800-985-3059.

Good Faith Estimates Disclaimer

Descargo de responsabilidad sobre estimaciones de buena fe - En Español

For Montana

Good Faith Estimates Disclaimer

Descargo de responsabilidad sobre estimaciones de buena fe - En Español