Insurance & billing

Good Faith Estimate notice

If you don’t have health insurance, or you choose not to use it for your care, you have the right to a Good Faith Estimate of what your care is expected to cost. Ask when you schedule or any time before: call 412-364-4100.

Last updated October 14, 2026

What is a Good Faith Estimate, and who can ask for one?

It is a written estimate of the expected charges for your care, and you can have one if you are uninsured or are not using insurance for your visits (self-pay).

The right comes from a federal law, the No Surprises Act. Its rules (45 CFR 149.610) ask health care providers to tell uninsured and self-pay patients that estimates are available, to give one when you schedule care or ask for one, and to post this notice where patients can find it.

What does the standard notice say?

The Centers for Medicare & Medicaid Services (CMS) publishes this notice for health care providers to share with patients; here it is word for word.

Standard notice (CMS)

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 certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.

You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers (opens another site), email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.

How do I ask for a Good Faith Estimate?

Call the office and say you are uninsured or paying for your care yourself; you can ask when you book a visit, or before you decide to schedule.

The estimate comes to you in writing, on paper or electronically, whichever you prefer.
Keep your estimate: compare it with your bill, and you will need it if you ever dispute a bill.
Prices are not listed on this website. To ask about costs or self-pay options, call the office.

Call 412-364-4100

What if my bill is higher than the estimate?

If a bill is at least $400 more than the Good Faith Estimate from that provider, you can dispute it through the federal patient-provider dispute resolution process.

Your initial bill must be dated within the last 120 calendar days (about 4 months) when you start the dispute.
CMS charges a $25 non-refundable administrative fee. If the dispute is decided in your favor, the fee is deducted from the amount you owe.
You will need a paper or digital copy of your Good Faith Estimate and of your bill; don’t send original documents.

Learn how the process works, or start a dispute, on the CMS page about disputing a bill (opens another site). If anything on a bill is unclear, you can always call the office first.

What if I am using insurance?

This notice is for patients who are uninsured or paying for themselves; if you plan to use insurance, see insurance and payment for the plans the practice accepts. Coverage depends on your plan.

Sources

45 CFR 149.610. Requirements for provision of good faith estimates of expected charges for uninsured (or self-pay) individuals. Electronic Code of Federal Regulations. (opens another site)
Providers inform uninsured and self-pay patients that Good Faith Estimates are available, with the notice prominently displayed on their website, in the office and where scheduling happens, and give an estimate on scheduling or on request.
Centers for Medicare & Medicaid Services. Sample Notice of Uninsured (or Self-Pay) Individual’s Right to Receive a Good Faith Estimate. Revised August 2023. (opens another site)
The standard notice reproduced word for word on this page, including the $400 dispute threshold and the CMS contacts; estimates are given on paper or electronically, in the format the patient prefers.
Centers for Medicare & Medicaid Services. Dispute a bill (patient-provider dispute resolution). Medical bill rights. (opens another site)
An initial bill dated within the last 120 calendar days, at least $400 above the estimate; a $25 non-refundable fee, deducted from what you owe if the dispute is decided in your favor; copies, not originals.