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Covenant Medical Group

Covenant Health System

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 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.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least one (1) business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• 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, call Covenant Medical Group at 865-374-5200 or CMS at 1-800-985-3059, or visit www.cms.gov/nosurprises.

You may also contact the Tennessee Department of Commerce & Insurance on its website at https://www.tn.gov/commerce/insurance/consumer-resources.html or by calling TDCI’s Consumer Insurance Services team at 1-800-342-4029 or 615-741-2218.

Resources

Printed versions of this notice are also available to patients at the patient registration desk.