Upon the request of any person without health coverage or with an insurance deductible of five thousand dollars ($5,000) or higher, a hospital shall, within five (5) calendar days, provide that person with a written estimate based upon the best medical information known at the time, of the amount the hospital will require the person to pay for the healthcare services, procedures, and supplies that are reasonably expected to be provided to the person by the hospital, based upon an average length of stay and services provided for the person’s diagnosis and including the amount for any facility fees required. The estimate may also indicate that it does not reflect any unanticipated services that become apparent at the time of treatment. The hospital may provide this estimate during normal business office hours. In addition to the estimate, the hospital shall provide information about its financial assistance and charity care policies and contact information for a hospital employee or office from which the person may obtain further information about these policies. If requested, the hospital shall also provide the person with an application for financial assistance or charity care. This section shall not apply to emergency services.