Good Faith Estimate & No Surprises Act Notice

Last Updated: March 2026

Your Right to a Good Faith Estimate

Under federal law, healthcare providers are required to give patients who don’t have insurance, or who choose not to use insurance, an estimate of expected charges for medical services. This is called a Good Faith Estimate (GFE).

About the No Surprises Act

The No Surprises Act (effective January 1, 2022) is a federal law designed to protect patients from unexpected medical bills. It applies to emergency services, certain non-emergency services provided by out-of-network providers at in-network facilities, and air ambulance services.

Under the No Surprises Act, you are protected from:

Surprise billing for emergency services, even if received from an out-of-network provider
Surprise billing for certain services at in-network facilities from out-of-network providers
Out-of-network cost sharing that exceeds in-network amounts in certain situations

What the Good Faith Estimate Includes

A Good Faith Estimate provides an itemized list of expected charges, including:

Expected charges for the primary service or procedure
Expected charges for related services (e.g., diagnostic imaging, laboratory tests)
Expected charges from co-providers (e.g., anesthesiologists, pathologists)
Expected charges for prescription drugs, medical equipment, and hospital fees

How to Request a Good Faith Estimate

You have the right to request a Good Faith Estimate before any scheduled, non-emergency healthcare service.

Timing requirements under federal law:

For services scheduled at least 3 business days in advance: the GFE must be provided within 1 business day of scheduling
For services scheduled at least 10 business days in advance: the GFE must be provided within 3 business days of scheduling

To request a Good Faith Estimate, contact:

Phone: (866) 264-0827
Visit: 255 E 90th Dr, Merrillville, IN 46410

Patient Dispute Resolution

If you receive a final bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill through the Patient-Provider Dispute Resolution (PPDR) process established by the Centers for Medicare & Medicaid Services (CMS).

You must initiate the dispute within 120 calendar days of receiving the bill
A $25 administrative fee applies (may be refunded if the dispute is resolved in your favor)
An independent third party will review the dispute and issue a binding determination

Important: Make sure to save a copy or picture of your Good Faith Estimate for your records.

Indiana Surprise Billing Protections

In addition to federal protections, Indiana law (IC 27-8-11) provides additional surprise billing protections. The Indiana Department of Insurance oversees compliance with state surprise billing laws and can assist with complaints.

Indiana patients may contact the Indiana Department of Insurance at 1-800-622-4461 or visit www.in.gov/idoi for assistance with surprise billing concerns.

Good Faith Estimates for MVA Lien Patients

If you are receiving treatment under a medical lien arrangement as a motor vehicle accident (MVA) patient, it’s important to understand how Good Faith Estimates intersect with lien-based treatment.

Under Indiana law (IC 32-33-2), a medical lien allows your healthcare provider to be paid from the proceeds of your personal injury settlement or judgment. Key points for lien patients:

You are still entitled to a Good Faith Estimate of expected treatment charges
The GFE provides transparency into expected costs, even though payment is deferred until settlement
The lien amount may differ from the GFE if your treatment needs change during care
Under Indiana’s lien statute, patients retain a minimum of 20% of their settlement even if medical liens exceed 80% of the settlement value
Your attorney will negotiate lien amounts as part of the overall case settlement process

If you have questions about how the Good Faith Estimate applies to your lien-based treatment, our billing team is available to assist you.

For More Information

For questions about your right to a Good Faith Estimate, or to learn more about the No Surprises Act:

Call us: (866) 264-0827
Visit us: 255 E 90th Dr, Merrillville, IN 46410
CMS information: www.cms.gov/nosurprises