Good Faith Estimate for Self-Pay Patients

Effective date: November 7, 2026

You have the right to receive a Good Faith Estimate explaining how much your care will cost

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for their care.

• You 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 exams, tests, supplies and fees.
• Make sure we know at least 3 business days before your appointment that you’d like an estimate and that you’re paying yourself. You can also ask for an estimate before you schedule.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

To ask for an estimate, call us at 610-868-6800. See How you pay for how payment works at our office.

For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises or call 1-800-985-3059.