Your Right to a Good Faith Estimate: How to Use It to Fight Overcharges

Imagine hiring a contractor to remodel your kitchen. They give you a written estimate of $15,000. When the job is done, they hand you a bill for $32,000 — more than double — and say "pay up." You'd be furious. You might call a lawyer.

In healthcare, this happens constantly. Or at least, it did — until the Good Faith Estimate became law.

Under the No Surprises Act, healthcare providers are now required to give you a written estimate of expected charges before you receive non-emergency care. And if the final bill exceeds that estimate by more than $400, you have the legal right to dispute it.

This is one of the most powerful — and most underused — patient protections in American healthcare. Here's exactly how to use it.

What Is a Good Faith Estimate?

A Good Faith Estimate (GFE) is a written document from your healthcare provider listing the expected charges for a scheduled or requested healthcare service. It must include:

• Patient information — Your name, date of birth, and contact info
• Description of each service — Itemized list of expected services, including diagnostic codes and procedure codes
• Expected charges for each service — From every provider and facility involved
• Provider and facility information — Name, NPI number, and Tax ID for each
• Disclaimers — That the estimate may change if medical circumstances change, and information about the dispute process

Think of it as the healthcare equivalent of a contractor's written estimate — a binding-ish document that holds the provider accountable to their quoted price.

Who Gets a Good Faith Estimate?

Currently, the GFE right applies primarily to:

• Uninsured patients — Anyone without health insurance coverage
• Self-pay patients — Anyone choosing not to file a claim with their insurance (even if they have coverage)

The No Surprises Act originally intended GFE protections to expand to insured patients as well, with estimates sent to both the patient and their insurer. This expansion has been delayed and is being implemented in phases. Check current CMS guidance for the latest status.

Pro tip: Even if you have insurance, you can request a GFE by indicating you plan to self-pay. This gives you a price to compare against what your insurance processes.

When Must Providers Give You a GFE?

Providers must provide a Good Faith Estimate:

• When you schedule a service — The GFE must be provided within 1 business day if the service is scheduled at least 3 business days in advance, or within 3 business days if the service is scheduled at least 10 business days ahead.
• When you request one — You can request a GFE from any provider for any non-emergency service, and they must provide it within 3 business days.

The GFE requirement applies to all healthcare providers and facilities, including:

• Hospitals and surgical centers
• Doctor's offices and clinics
• Labs and imaging centers
• Mental health providers
• Physical therapists
• Dentists (in some contexts)

How to Request a Good Faith Estimate

Step 1: Ask Before You Schedule

When scheduling any non-emergency medical service, say: "I'd like a Good Faith Estimate of all charges associated with this service, as required under the No Surprises Act."

Be specific about what you're requesting. Ask for estimates from:

• The facility (hospital, surgery center, etc.)
• The primary provider (your surgeon, specialist, etc.)
• Any other providers who might be involved (anesthesiologist, pathologist, assistant surgeon, etc.)

Step 2: Get It in Writing

The GFE must be in writing — paper or electronic. Don't accept a verbal estimate over the phone. If they give you a number verbally, say: "I need that as a written Good Faith Estimate. Can you email or mail it to me?"

Step 3: Review It Carefully

When you receive the GFE, check:

• Are all expected services listed? For a surgery, that should include the surgical procedure, anesthesia, facility fees, lab work, imaging, and post-operative care.
• Are all providers listed? Each provider billing separately should have their charges included.
• Do the charges seem reasonable? Compare against Taven's provider comparison data or Medicare rates for the same procedures.
• Is the diagnosis code correct? The wrong diagnosis can lead to inflated estimates (or insurance denials later).

Step 4: Save It

Keep your GFE in a safe place. You'll need it to compare against your actual bill — and as evidence if you need to dispute overcharges.

The $400 Rule: Your Right to Dispute

Here's where the GFE becomes a powerful tool. If your final bill exceeds your Good Faith Estimate by $400 or more, you have the right to initiate a patient-provider dispute resolution process.

How the Dispute Process Works

1. You initiate the dispute. You must start the process within 120 days of receiving the bill. File through the CMS dispute resolution portal or call the No Surprises Help Desk at 1-800-985-3059.
2. You provide documentation. Submit your Good Faith Estimate, the actual bill, and any supporting information explaining why you believe the charges are excessive.
3. A dispute resolution entity (DRE) reviews the case. An independent third party — not affiliated with the provider or any insurer — evaluates whether the charges are reasonable compared to the estimate.
4. A decision is made. The DRE determines the appropriate payment amount. This decision is binding on the provider.

Important Details

• The $400 threshold is per provider or facility. If the hospital's charges are $450 over the estimate but the surgeon's are accurate, you can dispute the hospital's portion.
• There's a small administrative fee to initiate the dispute (around $25), which may be refunded if you win.
• You should not be sent to collections while the dispute is pending.
• The provider is bound by the outcome — if the DRE determines a lower amount, the provider must accept it.

Situations Where the GFE Is Most Valuable

Planned Surgeries and Procedures

This is the primary use case. Before any scheduled surgery — knee replacement, hernia repair, planned C-section — request a GFE from every provider involved. The estimate becomes your price benchmark.

Expensive Diagnostic Tests

MRIs, CT scans, PET scans, and specialty blood panels can generate surprise bills. Get a GFE before scheduling.

Mental Health and Therapy

If you're self-paying for therapy or psychiatric care, request a GFE for your expected course of treatment. This is especially important for intensive outpatient programs or residential treatment.

Dental Work

Major dental procedures (implants, crowns, oral surgery) can be expensive and variable. While dental-specific GFE requirements may vary, requesting an estimate is always smart.

Shopping for Care

Request GFEs from multiple providers for the same procedure. Now you can compare prices — something that was nearly impossible before these transparency requirements. Combined with Taven's provider comparison tool, you can make truly informed decisions about where to receive care.

What to Do If a Provider Refuses to Give You a GFE

Providers are legally required to provide a GFE under the No Surprises Act. If they refuse:

1. Cite the law. Say: "Under the No Surprises Act, Section 2799B-6, I'm entitled to a Good Faith Estimate for non-emergency services. I'm requesting one in writing."
2. Ask for a supervisor. Front-desk staff may not be familiar with the requirement. Ask to speak with a billing manager or patient financial services.
3. Follow up in writing. Send an email or letter documenting your request and the date you made it.
4. File a complaint. Report the provider to CMS at 1-800-985-3059 or through the CMS No Surprises Act enforcement portal. You can also file a complaint with your state Department of Insurance or state attorney general.

GFE Limitations and Fine Print

• Estimates can change. If your medical situation changes (e.g., the surgeon discovers something unexpected during a procedure), additional charges may be justified. The GFE covers the expected scope, not unforeseen complications.
• Emergency care is excluded. GFEs apply to scheduled, non-emergency services. You can't request one in the middle of an emergency (though EMTALA protections and the No Surprises Act's balance billing provisions apply).
• The estimate is not a guarantee of final cost. It's an estimate. But the $400 dispute threshold means it's an estimate with teeth.
• Insured patient protections are still evolving. Full GFE implementation for insured patients has been delayed. The current strongest protections are for uninsured and self-pay patients.

Good Faith Estimate Checklist

• ✅ Request a GFE for any scheduled non-emergency service
• ✅ Get it in writing — don't accept verbal estimates
• ✅ Ensure all providers are included — facility, physician, anesthesia, etc.
• ✅ Compare the estimate with other providers and market rates
• ✅ Save the document for comparison with your actual bill
• ✅ Compare your final bill to the GFE line by line
• ✅ If the bill exceeds the GFE by $400+, initiate the dispute process within 120 days
• ✅ Don't pay the disputed amount until the dispute is resolved

The Bottom Line

The Good Faith Estimate is a game-changer for healthcare price transparency. For the first time, patients have a legally mandated right to know what care will cost before they receive it — and a formal process to fight back when the bill doesn't match.

Is it perfect? No. The insured patient expansion has stalled, enforcement is still developing, and many patients don't even know the right exists. But for uninsured and self-pay patients, it's one of the strongest consumer protections in healthcare.

Use it. Every time. Request the estimate, compare the bill, and dispute overcharges. The law is on your side — but only if you invoke it.

Need help understanding your bill or comparing it to your estimate? Taven's bill review tool can analyze your charges, and our provider comparison shows what fair market rates look like in your area.