MEDICAL BILLS

What is a good faith estimate for medical costs?

SHORT ANSWER

A good faith estimate is a written prediction of what a service will cost, which providers must give uninsured and self-pay patients before scheduled care under the No Surprises Act. If your final bill is much higher than the estimate, you may be able to dispute the difference.

The good faith estimate is a consumer protection built into the federal No Surprises Act. If you are uninsured or paying out of pocket, providers are generally required to give you a written estimate of expected charges before scheduled care, so you are not blindsided by the bill. It also creates leverage after the fact: if your actual bill exceeds the estimate by a defined margin, you may be entitled to use a patient-provider dispute process to challenge the excess. Keeping the estimate is what makes that possible.

What to do, in order

  1. If you are uninsured or self-pay, ask for a good faith estimate before scheduled care.
  2. Keep the estimate — you will need it to compare against the final bill.
  3. When the bill arrives, compare it line by line to the estimate.
  4. If the bill substantially exceeds the estimate, ask about the patient-provider dispute process.
  5. Combine this with an itemized-bill review to catch coding errors too.

Common questions

Who gets a good faith estimate?

Primarily uninsured and self-pay patients, before scheduled care. Insured patients generally get cost information through their plan instead.

What if my bill is much higher than the estimate?

If it exceeds the estimate by the threshold set under the No Surprises Act, you may be able to dispute the difference through the patient-provider dispute resolution process.

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Authoritative sources

Primary government sources. This page summarizes them in plain language; the linked pages are the authority.
This is general information, not legal, tax, or financial advice, and it doesn’t create a professional relationship. Rules have exceptions and change over time. For advice on your specific situation, consult a licensed professional.