How to Request a Good Faith Estimate Under the No Surprises Act

Paying for health care without insurance used to mean agreeing to a price you couldn’t see until the bill arrived. That changed on January 1, 2022, when the good faith estimate rules under the federal No Surprises Act took effect.

If you’re uninsured, or you choose not to use your insurance for a service, you have a legal right to a written estimate of what you’ll be charged before you get care. And if the bill comes in far above that estimate, there’s a federal process to dispute it.

This guide explains who qualifies, how to ask, what the estimate must include and exactly what to do if your bill doesn’t match. This is general information, not legal or medical advice.

What a good faith estimate is

A good faith estimate (GFE) is a written list of the items and services a provider or facility expects to deliver for your care, with the expected charge for each. It’s part of the No Surprises Act, which Congress passed as part of the Consolidated Appropriations Act, 2021.

According to the Centers for Medicare & Medicaid Services (CMS), providers and facilities must give a good faith estimate to people who are uninsured or self-pay, either when they schedule an item or service or when they ask about costs.

A good faith estimate is not a bill and not a guarantee. CMS notes it’s based on what’s known when it’s created, and you could be charged more if complications or special circumstances come up. But it creates a baseline that matters if your final bill is much higher.

Who qualifies for a good faith estimate

You can usually get a good faith estimate if:

• You don’t have health insurance, or
• You have insurance but don’t plan to use it for a specific item or service, such as paying cash for therapy, or
• The service isn’t covered by your plan.

Who doesn’t qualify under these rules:

• People enrolled in Medicare, Medicaid, TRICARE and other federal health care programs. CMS says they aren’t eligible for good faith estimates because those programs have other billing protections.
• People using private insurance for the service. The law also calls for an “advanced explanation of benefits” from insurers for insured patients, but federal agencies have deferred enforcing that requirement until they complete further rulemaking. As of this writing, it still isn’t in effect.

Key takeaway: Tell the provider clearly, before care, that you’re uninsured or not using insurance. That statement is what triggers your right to a good faith estimate and, later, your right to dispute a bill.

How to request a good faith estimate, step by step

Step 1: Tell them you’re self-pay

When you call to schedule, or when you’re comparing prices, say you’re uninsured or not using insurance for this service. Ask for a good faith estimate in writing. Providers must post information about good faith estimates on their website and in their office.

Step 2: Ask early enough

CMS sets timing rules based on when you schedule:

When you schedule	When the provider must give you a GFE
0 to 2 business days before the service	Not required
At least 3 business days before the service	Within 1 business day of scheduling
At least 10 business days before the service	Within 3 business days of scheduling
You ask about cost without scheduling	Within 3 business days of your request

If you’re shopping around before booking, request estimates from several providers. Each one must respond within 3 business days.

Step 3: Get it in writing

The estimate can come on paper or electronically, such as by email or a patient portal. Providers may also walk through it with you by phone or in person, but you need a written copy to dispute a bill later. Save it as a PDF or photo.

Step 4: Ask for estimates from every provider involved

CMS explains that each estimate may only cover one provider or facility. For a surgery, you may need separate estimates from the surgeon, the hospital or surgery center, the anesthesiologist and any lab or imaging provider. Federal rules originally called for the main provider to include co-providers’ charges, but HHS has deferred enforcing that requirement pending future rulemaking. Ask each provider directly.

Step 5: Check it carefully

Review the estimate before your appointment using the checklist below. If something is missing or unclear, ask for a corrected estimate.

Step 6: Keep everything

Store the estimate, appointment confirmations and later bills together. You’ll need the estimate and the bill if you have to dispute.

What a good faith estimate must include

According to CMS guidance, a good faith estimate should include:

• Your name and date of birth.
• A description of the primary service and the date it’s scheduled, if scheduled.
• An itemized list of items and services the provider reasonably expects to provide, grouped by provider or facility.
• Diagnosis codes and service codes where applicable.
• Expected charges for each item or service.
• Provider or facility name, along with identifying details and the location where care will be delivered.
• A disclaimer explaining that the estimate isn’t a contract, that you can ask the provider to update or negotiate a higher bill or ask about financial assistance, and how to dispute a bill at least $400 above the estimate.

Recurring care, such as therapy

For recurring services like counseling or physical therapy, CMS allows a single good faith estimate that covers the expected frequency, number of sessions and total cost for up to 12 months. If your treatment changes significantly or continues beyond 12 months, you should get a new estimate. This matters if you’re paying cash for therapy; see our guide to finding an online therapist who takes insurance if you’d rather use coverage.

How to dispute a bill that exceeds the estimate

If your bill is much higher than your estimate, you have 2 paths: talk to the provider first, then use the federal dispute process if needed.

Option 1: Contact the provider

CMS says you can ask the provider to update the bill to match the good faith estimate, negotiate the bill, or ask about financial assistance. Many disputes end here. Our guide on how to negotiate a medical bill has scripts and tips.

Option 2: Use the patient-provider dispute resolution process

You may be eligible for the federal patient-provider dispute resolution (PPDR) process if all of these apply, according to CMS:

• You were uninsured or didn’t use insurance, and told the provider before care.
• You got care on or after January 1, 2022.
• You received a good faith estimate.
• Your bill from one provider or facility is at least $400 more than that provider’s estimate. The $400 test is applied separately to each provider, and it counts charges for items that weren’t on the estimate.
• You start the dispute within 120 calendar days of the date on your initial bill.

How to file

1. Gather documents: your good faith estimate, the bill and the provider’s contact information. Readable photos or copies are fine; don’t mail originals.
2. Submit online through the CMS billing dispute portal (recommended), or by mail or fax using the CMS dispute initiation form.
3. Pay the $25 administrative fee. CMS says the dispute doesn’t start until the fee is paid.
4. Respond to requests from the independent reviewer, called a selected dispute resolution (SDR) entity. If something is missing, you’ll typically have a set window to supply it.

What happens next

The independent reviewer decides what you owe. Under CMS guidance, if the provider can’t show the higher charge was for a medically necessary item or service caused by unforeseen circumstances, you’ll typically owe the estimate amount. If you win any reduction, the $25 fee is subtracted from what you owe. If the reviewer sides with the provider, you pay the billed amount.

You can also settle with the provider during the process. If you do, CMS says the provider must reduce your settlement amount by at least half the administrative fee.

Your protections during a dispute

While your dispute is pending, CMS says the provider or facility can’t send your bill to collections or threaten to, can’t collect late fees until the process ends and can’t retaliate against you. If the bill is already in collections, they must stop pursuing it until the dispute is resolved.

What to do if you didn’t get an estimate

If you should have received a good faith estimate and didn’t, you can submit a complaint to CMS through the No Surprises Help Desk at 1-800-985-3059 or online. CMS says help is available in more than 350 languages. Filing a complaint doesn’t change what you owe, so keep working with the provider on the bill itself.

Without an estimate, you can’t use the PPDR process for that bill. You can still negotiate, ask for an itemized bill and request financial assistance. Our guide on how to read a medical bill explains how to spot errors and duplicate charges.

Tools that make price shopping easier

A good faith estimate is one piece of a larger push for price transparency. Before you schedule:

• Use hospital price transparency tools to compare cash prices. See our guide on how to use hospital price transparency tools.
• Ask for the cash or self-pay discount. Many providers offer lower prices to patients paying directly.
• Request your records if you need to share them with a new provider; see how to get copies of your medical records online.
• Use your patient portal to store estimates and bills in one place.

Where to start

1. Before your next scheduled service, tell the office you’re uninsured or self-pay.
2. Ask for a written good faith estimate from every provider involved.
3. Check the estimate for codes, itemized charges and the dispute disclaimer.
4. Save the estimate and every bill together.
5. If a bill is $400 or more over a provider’s estimate, contact the provider first, then file a dispute within 120 days if needed.
6. Call the No Surprises Help Desk at 1-800-985-3059 if you have questions or didn’t get an estimate.

The bottom line

If you pay for care yourself, the good faith estimate is one of your strongest protections. Ask for it in writing every time you schedule, get one from each provider involved and keep it until the bill is settled. If a bill comes in at least $400 over a provider’s estimate, you have 120 days to dispute it for a $25 fee, and the provider can’t send you to collections while it’s under review. For other billing terms, see our glossary.

This is general information, not legal or medical advice.

Sources

• CMS: What is a good faith estimate? — who can get an estimate, timing rules, separate estimates per provider, No Surprises Help Desk number
• CMS: Dispute a medical bill — eligibility, $400 threshold, 120-day deadline, $25 fee, how to file and protections during a dispute
• CMS: Understanding the good faith estimate and patient-provider dispute resolution process — required contents, federal program exclusions, advanced EOB deferral, how reviewers decide
• CMS: Good faith estimate FAQs, part 2 — single estimate for recurring services up to 12 months
• CMS: Good faith estimate FAQs on co-provider enforcement — deferred enforcement of co-provider and co-facility charges