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Good Faith Estimate Notice

October 28, 2025 Policies & Notices

Good Faith Estimate Notice

Your Right to a Good Faith Estimate

You have the right to receive a Good Faith Estimate that explains how much your medical care is expected to cost. This estimate helps you plan for your care and understand charges before you receive services.

What the Law Requires

Under federal law (the No Surprises Act), all healthcare providers must give patients without insurance—or those choosing not to use insurance—a written estimate of the expected charges for medical items and services.

This estimate includes:

  • The total expected cost of scheduled, non-emergency services
  • Related costs such as medical tests, prescription drugs, equipment, and facility fees

When You’ll Receive a Good Faith Estimate

You have the right to receive your estimate:

  • At least one business day before your scheduled non-emergency service or procedure
  • Upon request, even if you haven’t scheduled yet

Your estimate must be provided in writing—not just verbally. Be sure to save a copy for your records.

If Your Bill Is Higher Than Expected

If you receive a bill that is $400 or more above your Good Faith Estimate, you have the right to dispute the charge.
You can start a dispute process with the U.S. Department of Health and Human Services (HHS).

For details on how to dispute a bill, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Questions or Support

If you have questions about your estimate or your rights, please contact:
Community Health Net
(814) 455-7222
or visit www.cms.gov/nosurprises for more information.

Discover More Ways We Can Help

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About

Community Health Net (CHN) is a Federally Qualified Health Center with seven locations and over 40 years of service to the Erie region. CHN delivers accessible medical, dental, vision, behavioral health, sports medicine, and pharmacy services, regardless of a patient’s ability to pay.

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