Your Right to a Good Faith Estimate

San Francisco AIDS Foundation and SFAF Pharmacy

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

Federal law requires health care providers to give patients who don’t have insurance, or who choose not to use their insurance, an estimate of the bill for their care before they receive it.

You can get a Good Faith Estimate if:

• you don’t have health insurance, or
• you have insurance but choose not to use it for your visit. This includes patients who choose confidential self-pay to keep a visit private from their health plan.

If you are using your insurance, the law doesn’t require a Good Faith Estimate. You can still ask us what your visit is likely to cost, and we will tell you.

Just ask. You can ask when you schedule a visit, at the front desk, or by calling us. If you ask us anything about what a visit or service will cost, we treat that as a request for a Good Faith Estimate.

• If you schedule a visit at least 3 business days ahead, you will get your estimate within 1 business day after scheduling.
• If you schedule a visit at least 10 business days ahead, you will get your estimate within 3 business days after scheduling.
• If you ask for an estimate without scheduling a visit, you will get it within 3 business days after you ask.

If something changes before your visit, such as the services or the expected charges, we will give you a new estimate at least 1 business day before your visit.

Your estimate will be in writing, on paper or electronically, whichever you prefer. It will list:

• the main service you are scheduling and the date, if it is scheduled
• other services we expect to provide during the same visit, such as lab tests
• the expected charge for each service, including any sliding-scale discount you qualify for

A Good Faith Estimate is not a contract. You don’t have to get care from us because you received an estimate. Actual charges may be different. Your provider may also recommend other care that needs a separate estimate.

If you don’t have insurance, you may qualify for free or reduced-cost care based on your income. Ask our staff about our sliding fee discount program.

If your bill is at least $400 more than your Good Faith Estimate, please contact us first. We will review the bill with you.

You also have the right to dispute the bill through a federal process. You must start the dispute within 120 calendar days (about 4 months) of the date on the original bill. Starting a dispute will not affect the quality of care you receive from us.

Keep a copy of your Good Faith Estimate and your bill. If you lose your estimate, we can give you a copy of any estimate we issued in the last 6 years.

To learn more or to start a dispute, visit www.cms.gov/nosurprises or call 1-800-985-3059.

This information is available in Spanish and other languages, and in accessible formats, at no cost. Please ask our staff.

Contact our billing team:

• Phone: (415) 581-1600
• Email: prep@sfaf.org
• Mail or visit: 470 Castro Street, San Francisco, CA 94114

San Francisco AIDS Foundation and Strut SFAF LLC, doing business as SFAF Pharmacy

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