No Surprises Act

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers are required to provide patients who either do not have insurance or are choosing not to use insurance (Self-pay patients) an estimate of the anticipated bill for medical items and services.

• Self-pay patients 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.
• Your health care provider must provide a Good Faith Estimate in writing at least 1 business day before your scheduled medical service or item. You may also ask your health care provider, and any other provider you choose, for a Good Faith Estimate prior to scheduling.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.
• You are advised to save a copy (or picture of) your Good Faith Estimate.

To request a Good Faith Estimate, please email care@mlpt.com and provide us with your name, email address, and phone number.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises