Good Faith Estimate Rights

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

If you do not have certain types of health care coverage, or if you choose not to use your health care coverage for services, you generally have the right to receive a written Good Faith Estimate of expected charges before receiving care.

You may request a Good Faith Estimate before scheduling services. The estimate should be provided:

  • Within 3 business days of your request if care has not yet been scheduled.
  • Within 1 business day after scheduling if your appointment is scheduled 3 to 9 business days in advance.
  • Within 3 business days after scheduling if your appointment is scheduled 10 or more business days in advance.

A Good Faith Estimate explains the expected costs of your care. Ask your provider about any related services that may be recommended and whether separate estimates may be required for those services.

If you receive a bill from a provider or facility that is at least $400 more than the Good Faith Estimate provided by that provider or facility, you may be eligible to dispute the charges through the federal patient-provider dispute resolution process.

Please keep a copy of your Good Faith Estimate and any bills you receive.

Request a Good Faith Estimate

To request a Good Faith Estimate from Cupertino Dental Group, please contact our Financial Coordinators at (408) 257-3031.

Questions About Your Rights?

For more information about your rights under the No Surprises Act or the federal dispute resolution process: