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Good Faith Estimate

At Daviess Community Hospital, we believe in price transparency and empowering patients with clear, upfront information about the cost of care. If you are uninsured or not using insurance for your care, you have the right to receive a Good Faith Estimate of expected charges for non-emergency services.

This estimate outlines your anticipated out-of-pocket costs before you receive care—helping you make informed financial decisions about your healthcare.


What Is a Good Faith Estimate?

A Good Faith Estimate (GFE) is a written estimate of what you can expect to pay for medical services and items. It includes services that are scheduled in advance and are not urgent or emergency care. This estimate is based on information known at the time of scheduling and does not guarantee final charges.


Who Can Request a Good Faith Estimate?

You may request a Good Faith Estimate if:

  • You do not have insurance
  • You do not plan to use insurance to pay for your care
  • The service is scheduled or referred in advance
  • The care is non-emergent

You may also request an estimate at any time—even before scheduling care.


When Will You Receive Your Estimate?

For uninsured or self-pay patients:

  • Care scheduled 10+ business days in advance: Estimate provided within 3 business days
  • Care scheduled 3–9 business days in advance: Estimate provided within 1 business day
  • Care scheduled less than 3 business days in advance: A Good Faith Estimate is not required

For insured patients:

  • You may request an estimate for scheduled services. Daviess Community Hospital will provide it within 3 business days of your request.


Important Notes

  • Good Faith Estimates are non-binding and may vary based on your medical condition, additional services needed, or updated care plans.
  • Estimates are valid for 30 days from the date issued.
  • You have the right to dispute a bill that is significantly higher than your estimate. Learn more about this process at cms.gov/nosurprises.

How to Request a Good Faith Estimate

To request your estimate, please provide the following:

  • Patient name
  • Scheduled service or procedure
  • Ordering provider (if applicable)
  • Preferred delivery method (email, phone, fax, or mail)

Submit Your Request:

If you have any questions, our Patient Financial Services team is here to help. We are committed to helping you understand your medical costs and providing care with compassion and transparency.

Your Rights and Protections Against Surprise Medical Bills