Good Faith Estimate
You have the right to receive a "Good Faith Estimate" explaining
how much your medical care will cost.
Please call 317-421-5678 for your estimate.
If you don't have insurance or don't intend to use insurance to
pay for scheduled non-emergency health care services, federal law requires that health care providers and facilities provide
you with an estimate of the expected charges for medical items and services
at least 1 business day before the scheduled services are to be performed.
If you are uninsured or not using insurance to pay for your health care
services and receive a bill that is at least $400 more than your Good
Faith Estimate, you can dispute the bill.
Any patient may request an estimate of the expected charges for non-emergency health
care services that have been ordered, scheduled, or referred and state
law requires that health care providers and facilities provide you with
an estimate of the expected bill for medical items and services within
5 business days of the request.
- 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.
- If you request an estimate and the actual charge for the health care services
exceeds your Good Faith Estimate by the greater of: (i) $100; or (ii)
5%, we will provide a written explanation as to why the charges exceed
- 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/consumers or call