Good Faith Estimate: Know Your Healthcare Costs Before Treatment
Under the No Surprises Act, you have the legal right to receive a written estimate of expected charges before scheduled medical services. If your final bill is $400+ more than the estimate, you can dispute it. Most patients don't know this right exists.
What Is a Good Faith Estimate?
A Good Faith Estimate (GFE) is a written document that details the expected total cost of healthcare services you're scheduling. It was established by the No Surprises Act, which took effect January 1, 2022, as a major consumer protection for patients.
Think of it like a contractor's quote before a home renovation — you get to see the itemized costs before agreeing to the work. If the final bill comes in significantly higher than the estimate, you have legal recourse.
💡 Key point: A Good Faith Estimate is not just a courtesy — it's a federal legal requirement. Providers who refuse to give you one are violating the law.
Who Is Entitled to a Good Faith Estimate?
You have the right to a GFE if you fall into any of these categories:
- Uninsured patients — you don't have any health insurance
- Self-pay patients — you have insurance but choose not to use it for this service
- Anyone who asks — even insured patients can request a GFE, though the dispute protections currently apply to uninsured/self-pay patients
⚠️ Important: You do NOT need to explain why you're self-pay. If you tell a provider you're not using insurance, they must provide a Good Faith Estimate. No questions asked.
What Must a Good Faith Estimate Include?
A valid GFE isn't just a ballpark number. By law, it must contain:
- Itemized list of services — every service, procedure, test, or item expected to be provided
- Expected charges — the anticipated cost for each line item
- Provider information — name, National Provider Identifier (NPI), and Tax Identification Number (TIN)
- Diagnosis codes — the ICD-10 codes associated with your care
- Service location — where the care will be provided
- Date(s) of service — when the care is expected to occur
- Disclaimer about dispute rights — information about your right to dispute bills that exceed the estimate by $400 or more
If any related providers will be involved (anesthesiologist, lab, radiologist, etc.), their charges should be included too — either on the same GFE or as separate estimates.
When Must Providers Give You a Good Faith Estimate?
The timeline depends on how far in advance the service is scheduled:
- Service is 3+ business days away: Provider must deliver the GFE within 3 business days of scheduling
- Service is within 3 business days: Provider must deliver the GFE within 1 business day of scheduling
- Patient requests a GFE (without scheduling): Provider must deliver within 3 business days of the request
📋 Pro tip: Always request your GFE in writing (email or patient portal) so you have a paper trail. Verbal estimates don't count for dispute purposes.
What If Your Final Bill Is $400+ More Than the Estimate?
This is where the Good Faith Estimate becomes truly powerful. If your final bill exceeds the GFE by $400 or more, you have the right to initiate a patient-provider dispute resolution process.
How the Dispute Process Works
- Compare your bill to the GFE Review your final bill against the Good Faith Estimate. Calculate the total difference. If it's $400+ over, you're eligible.
- File a dispute with CMS You must initiate the dispute within 120 calendar days of receiving the bill. File through the CMS dispute resolution portal.
- Gather your documents You'll need: your original Good Faith Estimate, the final bill, and any supporting documentation (communication with the provider, receipts, etc.).
- CMS assigns a reviewer An independent dispute resolution entity will review your case, typically within 30 business days.
- Get a determination The reviewer will decide the appropriate charge. If they rule in your favor, the provider must accept the lower amount.
🚨 Don't miss the deadline! You have exactly 120 calendar days from the date you received the bill to file a dispute. After that, you lose this right. Use our checker tool below to verify your eligibility.
How to Request a Good Faith Estimate: Step by Step
- Contact the provider's billing department Call or visit the billing or financial services department. Ask specifically for a "Good Faith Estimate under the No Surprises Act."
- Provide your information Give them your name, date of birth, and the specific service or procedure. State that you are uninsured, self-pay, or choosing not to use insurance for this service.
- Request it in writing Ask for the GFE in writing — paper or electronic. Verbal quotes don't carry the same legal protections.
- Confirm the timeline They must provide it within 3 business days of your request (or 1 business day if the service is less than 3 days away).
- Review and save the document Check that all expected services are listed and itemized. Save the document — you'll need it if the final bill is significantly higher.
- Compare with your final bill after treatment When you receive your bill, compare it line-by-line to the GFE. If the total is $400+ more, you can dispute it with CMS within 120 days.
📞 Sample script: "Hi, I'm scheduling [procedure] and I'd like to receive a Good Faith Estimate as required under the No Surprises Act. I'll be self-pay for this service. Can you please provide the estimate in writing?"
GFE Dispute Checker
Check if your final bill qualifies for a Good Faith Estimate dispute
Good news — your final bill is at or below your Good Faith Estimate (or the difference is less than $400). You're not eligible for the federal dispute process, but that's because your provider gave you an accurate estimate.
If you still think the charges are too high, you can review your bill to see how your charges compare to what other hospitals charge, or generate a negotiation letter.
Your bill exceeds the Good Faith Estimate, but the difference is less than $400. This means you're not eligible for the federal patient-provider dispute resolution process.
However, you still have options:
- Contact the provider — ask them to explain the additional charges and whether they can adjust the bill
- Review your bill — compare your charges to fair market rates
- Send a negotiation letter — formally request a reduction
- Check state protections — your state may have additional billing protections