Billed more than your good faith estimate?

Who counts as uninsured or self-pay

For good faith estimate purposes, an 'uninsured (or self-pay) individual' includes a person who has no benefits for the item or service under a group health plan, individual or group health insurance, a Federal health care program, or an FEHB plan. (45 C.F.R. § 149.610(a)(2)(xiii)(A))

An 'uninsured (or self-pay) individual' also includes a person who has benefits under a group health plan, individual or group health insurance, or an FEHB plan but does not seek to have a claim submitted to that coverage (this paragraph does not list Federal health care programs). (45 C.F.R. § 149.610(a)(2)(xiii)(B))

When you should have received the estimate

CMS says that usually, if you are not using health insurance to pay, your health care provider must give you a good faith estimate of expected charges if you request one or schedule services at least 3 business days in advance. (CMS, What is a good faith health insurance estimate? (page last modified 08/25/2026))

For uninsured/self-pay patients, the good faith estimate is due within 1 business day after scheduling when the service is scheduled at least 3 business days ahead, and within 3 business days after scheduling when it is scheduled at least 10 business days ahead. (45 C.F.R. § 149.610(b)(1)(vi)(A)-(B)) When an uninsured/self-pay individual requests a good faith estimate, it is due no later than 3 business days after the request. (45 C.F.R. § 149.610(b)(1)(vi)(C))

“When you schedule care 0-2 business days in advance, you aren’t entitled to get a good faith estimate. When you schedule care 3-9 business days in advance, you’ll get the estimate within 1 business day. When you schedule care 10 or more business days in advance, you’ll get the estimate within 3 business days.”
CMS, What is a good faith health insurance estimate? (page last modified 08/25/2026)

Convening providers and facilities must treat any discussion or inquiry about the potential costs of items or services as a request for a good faith estimate. (45 C.F.R. § 149.610(b)(1)(iv)) Convening providers and facilities must give an uninsured/self-pay individual, on request, a copy of any good faith estimate issued to them within the last 6 years. (45 C.F.R. § 149.610(f)(1))

The dispute rules

For the patient-provider dispute process, a bill is 'substantially in excess' of the estimate when a provider's or facility's total billed charges are at least $400 more than the total expected charges on that provider's or facility's good faith estimate. (45 C.F.R. § 149.620(a)(2)(ii))

“(ii) Substantially in excess means, with respect to the total billed charges by a provider or facility, an amount that is at least $400 more than the total amount of expected charges listed on the good faith estimate for the provider or facility.”
45 C.F.R. § 149.620(a)(2)(ii)

An uninsured/self-pay individual may start patient-provider dispute resolution by submitting an initiation notice to HHS postmarked within 120 calendar days of receiving the initial bill containing the charges that are substantially in excess of the good faith estimate. (45 C.F.R. § 149.620(c)(1))

CMS says filing a patient-provider dispute requires a $25 non-refundable administrative fee, which is deducted from the amount you owe the provider if the dispute is decided in your favor. (CMS, Dispute a medical bill (page last modified 09/19/2026)) The regulation itself does not state a dollar amount for the dispute administrative fee; it says the amount is specified by the HHS Secretary through guidance (CMS currently states $25). (45 C.F.R. § 149.620(g)(2))

While the dispute is open

While a patient-provider dispute is pending, the provider or facility must not send the disputed bill to collections or threaten to, should stop collection efforts if it is already in collections, and must suspend late fees until the dispute concludes. (45 C.F.R. § 149.620(c)(5))

“(5) Prohibitions on collections. While the patient-provider dispute resolution process is pending, the provider or facility must not move the bill for the disputed item or service into collection or threaten to do so, or if the bill has already moved into collection, the provider or facility should cease collection efforts.”
45 C.F.R. § 149.620(c)(5)

CMS says that if you and the provider settle during the dispute, the provider must reduce your bill by at least $12.50 (half the $25 fee) and notify the independent reviewer. (CMS, Dispute a medical bill (page last modified 09/19/2026))

Need help?

CMS lists the No Surprises Help Desk phone number as 1-800-985-3059, for help submitting a complaint or finding next steps, with help in English, Spanish and over 350 other languages. (CMS, Submit a complaint (page last modified 09/19/2026))

Common questions

How much over the estimate does the bill have to be?

For the patient-provider dispute process, a bill is 'substantially in excess' of the estimate when a provider's or facility's total billed charges are at least $400 more than the total expected charges on that provider's or facility's good faith estimate. (45 C.F.R. § 149.620(a)(2)(ii))

How long do I have to start a dispute?

An uninsured/self-pay individual may start patient-provider dispute resolution by submitting an initiation notice to HHS postmarked within 120 calendar days of receiving the initial bill containing the charges that are substantially in excess of the good faith estimate. (45 C.F.R. § 149.620(c)(1))

Can they send the bill to collections while I dispute it?

While a patient-provider dispute is pending, the provider or facility must not send the disputed bill to collections or threaten to, should stop collection efforts if it is already in collections, and must suspend late fees until the dispute concludes. (45 C.F.R. § 149.620(c)(5))