Your Right to Receive a Good Faith Estimate of Expected Charges
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 1-800-985-3059.
Who Can Get a Good Faith Estimate
You can get a Good Faith Estimate from GastroDoxs if you:
- Do not have health insurance, or
- Have health insurance but choose not to use it for your visit or procedure (self-pay).
If you plan to use insurance, please contact our billing team with your insurance information so we can help you understand your expected costs.
How to Request One
Tell our staff when you schedule that you are uninsured or self-paying, or ask for an estimate at any time before you schedule. You can call us at 832-632-4070, email info@gastrodoxs.com, or ask at the front desk.
We will give you a written Good Faith Estimate:
- Within 1 business day after scheduling, if your service is scheduled at least 3 business days ahead.
- Within 3 business days after scheduling, if your service is scheduled at least 10 business days ahead.
- Within 3 business days after you ask, if you request an estimate without scheduling.
Your estimate will list the expected services and their costs, including, where possible, related services from other providers and facilities involved in your care (for example, the endoscopy center, anesthesia and pathology). An estimate is not a contract, and actual charges may differ if your care changes.
If Your Bill Is Higher Than Your Estimate
If your bill is at least $400 more than your Good Faith Estimate from any one provider or facility, you may start a dispute through the federal patient-provider dispute resolution process within 120 calendar days of the date on the bill. Please also contact our billing team first, as we may be able to resolve the issue directly. Starting a dispute will not affect the quality of care you receive from us.
To learn more or to start a dispute, visit www.cms.gov/nosurprises or call 1-800-985-3059.
Need Help or Another Language?
This notice and your estimate are available in other languages and accessible formats at no cost. Call 832-632-4070. See also our Nondiscrimination & Language Assistance notice.