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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

                      • Physicians Regional Inpatient Rehabilitation Facility
                      • Physicians Regional Medical Center - Collier Boulevard
                      • Physicians Regional Medical Center - North
                      • Physicians Regional Medical Center - Pine Ridge
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                      An AllianceHealth Oklahoma® hospital

                      Services

                      • Bariatric Weight Loss Services
                      • Cancer Care
                      • Colorectal Care
                      • Critical Care Medicine
                      • Dermatology Services
                      • Digestive Health
                      • Emergency Services
                      • Endocrinology
                      • Gastroenterology
                      • Heart Care
                      • Infectious Disease Care
                      • Inpatient Rehab Facility
                      • Kidney Disorders
                      • Laboratory Services
                      • Neurology
                      • Orthopedic Services
                      • Pain Management
                      • Primary Care
                      • Pulmonology Care
                      • Radiology
                      • Rehabilitation Services
                      • Rheumatology
                      • Stroke Care
                      • Surgical Services
                      • Urgent Care
                      • Urology
                      • Vein Care Center
                      • Women's Health
                      • Wound Care and Hyperbaric Medicine

                      Patients & Visitors

                      • DAISY Award Nominations
                      • Events
                      • Financial Information
                      • Health Library
                      • Local Accommodations
                      • Online Scheduling
                      • Outpatient Instructions
                      • Patient Portal
                      • Payment, Billing & Assistance Policies
                      • Physician Referral
                      • Request Medical Records
                      • Your Stay

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