Common use of Good Faith Estimate Clause in Contracts

Good Faith Estimate. At your request, if you are intending to receive specific health care services, PIC will provide you with a good faith estimate of the allowable amount that PIC has contracted with a specified participating provider under PIC’s fee schedule for such specified health care service, the portion due from you (including deductible, coinsurance and copayments) and your out-of-pocket costs. An estimate provided to you under this paragraph is not a legally binding estimate of the fee schedule amount or your out-of-pocket cost. PIC will provide you such good faith estimate within ten business days from the day a complete request is received by PIC which includes all the patient and health care service information that PIC requires to provide a good faith estimate. For purposes of this section, a good faith estimate is not a guarantee of final costs for services received from a participating provider; or a final determination of eligibility for coverage of benefits or provider network participation under this contract.