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                      Your Right to a Good Faith Estimate


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

                      If you don't have insurance or don't intend to use insurance to pay for scheduled non-emergency health care services, federal law requires that health care providers and facilities provide you with an estimate of the expected charges for medical items and services at least 1 business day before the scheduled services are to be performed.

                      • If you are uninsured or not using insurance to pay for your health care services, and receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

                      Any patient may request an estimate of the expected charges for non-emergency health care services that have been ordered, scheduled or referred and state law requires that health care providers and facilities provide you with an estimate of the expected bill for medical items and services within 5 business days of the request.

                      • You have the right to receive a Good Faith Estimate for the total expected cost of any nonemergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
                      • If you request an estimate and the actual charge for the health care services exceeds your Good Faith Estimate by the greater of: (i) $100; or (ii) 5%, we will provide a written explanation as to why the charges exceed the estimate.
                      • 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/consumers or call 1-800-985-3059.

                      Affiliated Hospitals

                      • Northwest Health Physicians' Specialty Hospital
                      • Northwest Medical Center - Bentonville
                      • Northwest Medical Center - Springdale
                      • Siloam Springs Regional Hospital
                      • Willow Creek Women's Hospital
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                      An AllianceHealth Oklahoma® hospital

                      Services

                      • Bariatric Weight Loss Services
                      • Behavioral Health
                      • Breast Care
                      • Cancer Care
                      • Diabetes Care
                      • Diagnostic Imaging
                      • Digestive Health
                      • Ear, Nose & Throat Care
                      • Emergency Services
                      • Eye Care
                      • Family Medicine
                      • Geriatric Services
                      • Gynecology
                      • Heart Care
                      • Infectious Disease Care
                      • Laboratory Services
                      • Maternity Care
                      • Neurology
                      • Neonatal Intensive Care
                      • Orthopedic Services
                      • Pain Management
                      • Pharmacy
                      • Podiatry
                      • Pulmonology Care
                      • Rehabilitation & Physical Therapy
                      • Robotic Surgery
                      • Sleep Medicine
                      • Sports Medicine
                      • Stroke Care
                      • Surgical Services
                      • Urgent Care
                      • Urology
                      • Vascular Center
                      • Women's Health
                      • Wound Care

                      Patients & Visitors

                      • DAISY Award Nominations
                      • Events
                      • Financial Information
                      • Health Library
                      • MDSave
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                      • Pre-surgical Information
                      • Request Medical Records
                      • Spiritual Care

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