If you do not have a health plan or plan to pay for your health care bills yourself, healthcare providers or facilities must give you an estimate of expected costs when you schedule an appointment for a service, or if you request an estimate. This is known as a "Good Faith Estimate."

A Good Faith Estimate is NOT a bill.

The good faith estimate shows a list of expected charges for health services from your provider or facility. Because the good faith estimate is based on information known at the time your provider or facility creates the estimate, it will not include any unknown or unforeseen costs that may be added during the service received. Generally, the good faith estimate must include the expected charges for:

  • The primary scheduled service (medical evaluation, nutrition, imaging center, laboratory, dental, vaccination, EKG, health certificates).
  • Any other service that may reasonably be expected to be obtained as part of the primary service for that period of care.

The estimate may not include every service you receive from another provider or facility, even if some services seem related to the same service. For example, if you are going to undergo a surgical procedure, the good faith estimate might include the cost of the surgery, anesthesia, laboratory services, or tests.

Your Right to a Good Faith Estimate

Providers and facilities must give you a Good Faith Estimate:

  • If you schedule an appointment for a health service at least three (3) days before the date you will receive it, the provider must give you a good faith estimate no later than one (1) day after scheduling. If you schedule an appointment for a service, or ask about its cost, at least ten (10) days before the date you will receive it, the provider or facility must give you a good faith estimate no later than three (3) days after you schedule the appointment or request the estimate.
  • Including a list of every service (with the provider or facility) and specific details, such as the service code.
  • In a way that is clear and understandable to you, such as in large print or another form of communication you prefer.

Health care providers and facilities must also explain the Good Faith Estimate to you by phone or in person if you request it. They must then follow up with a written estimate (on paper or electronically), according to your preferred communication method.

Keep the estimate in a safe place so you can compare it with the bills you receive laterAfter receiving a bill for services, if the billed amount is $400 or more above the good faith estimate of expected costs, you may be eligible to dispute the bill.

If you believe you have been billed incorrectly,you can contact the Centers for Medicare and Medicaid Services (CMS) via www.cms.gov/nosurprises/consumers for more information about your rights under the federal "No Surprises Act," or by calling the information and complaints line at 1-800-985-3059.

If you believe you have been billed erroneously or that your rights under Act No. 134 of September 1, 2020(Puerto Rico's Patient Protection Against Surprise Medical Bills Act) have been violated, you can file a claim with the Office of the Insurance Commissioner of Puerto Rico via www.ocs.pr.gov, or by calling toll-free at 1-888-722-8686 or 787-304-8686. www.ocs.pr.gov o llamando libre de cargo al 1-888-722-8686 o al 787-304-8686.