Good Faith Estimate Information

You Have the Right to Receive a Good Faith Estimate

TSCN does not charge patients for care coordination. Health care services are provided and billed by independent participating providers and facilities. The provider or facility that schedules or furnishes your care is responsible for giving an applicable Good Faith Estimate.

If you do not have insurance or do not plan to use insurance to pay for an item or service, federal law generally requires the health care provider or facility to give you a Good Faith Estimate of expected charges when you request one or schedule qualifying care in advance.

The estimate should include expected charges for the scheduled item or service. Other providers or facilities involved in your care may issue separate estimates. An estimate is not a contract and does not require you to receive the service.

If you schedule care at least 3 business days in advance, the estimate is generally due within 1 business day after scheduling. If you schedule at least 10 business days in advance, or request an estimate before scheduling, it is generally due within 3 business days.

If a provider bills at least $400 more than that provider's Good Faith Estimate, you may be able to use the federal patient-provider dispute process. Save a copy of the estimate and bill.

For federal information, visit https://www.cms.gov/nosurprises or call 1-800-985-3059.

Requesting an Estimate

Ask the independent provider or facility that will furnish and bill for your care. A TSCN care coordinator can help identify the correct provider contact but cannot issue an estimate on behalf of an independent provider unless expressly authorized.

TSCN care coordination: 201-267-2460