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.

• This notice applies only to patients who do not have health insurance or have certain health insurance, but the items or services are not covered by such plans (uninsured patients) or have certain types of health insurance but choose not to use it (self-pay). This notice does not apply to patients who are insured under federal health care programs.
• 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, and equipment.
• You also have the right to request a Good Faith Estimate from any health care provider and/or facility providing services in connection with the items or services listed in the Good Faith Estimate that we provide to you by contacting those health care providers and/or facilities directly.
• If you schedule a health care item or service at least 3 business days in advance, we must give 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, we must give you a Good Faith Estimate in writing within 3 business days after scheduling. You may also request a Good Faith Estimate before you schedule an item or service, and we must provide it in writing within 3 business days or your request.
• If you receive a bill from us for the items and services listed in the Good Faith Estimate that is at least $400 more than the Good Faith Estimate, you can dispute the bill. If you receive a bill from any health care provider or facility in connection with the items and services provided in your Good Faith Estimate that is at least $400 more than the Good Faith Estimate you received from that health care provider or facility, you can dispute the bill with that health care provider or facility.
• To request a Good Faith Estimate, call 858-888-7730 or send an email to patientaccountspecialist@uniohp.com. Make sure to save a copy or picture of your Good Faith Estimate.
• For help or more information visit www.cms.gov/nosurprises.