You have the right to receive a “Good Faith Estimate” explaining how much your medical 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 medical items and services.

• You have the right to receive a Good Faith Estimate in writing at least 1 business day before your services 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.
• This GFE shows the costs of items and services that are reasonably expected for your healthcare needs for an item or service as of the date of this estimate. The estimate is based on information known at the time the GFE was created. The GFE does not include any unknown or unexpected costs that may arise during treatment.

You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.

You may contact us to let us know that billed charges are higher than the GFE. We will work with you to update the bill to match the GFE, negotiate the bill, or discuss how financial assistance may be available. Please call our billing line at 630-634-2602 to discuss.

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.

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