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Good faith estimates: how to get one and what to do when the bill is higher

If you pay for care yourself, federal law requires a written estimate before a scheduled service and lets you dispute a bill that comes in $400 or more above it. The exact steps.

By Martin S. Nielsen · 4 min read · updated 2026-09-19 · not medical advice

A good faith estimate (GFE) is a written statement of what a scheduled health service is expected to cost, given to you before it happens. Since January 2022 every provider and facility must give one to patients who are uninsured or who will pay themselves, and the estimate carries a legal consequence: if the final bill is $400 or more higher, you can have an independent reviewer settle it.

Who is entitled

Anyone who is uninsured, and anyone with insurance who tells the provider they will not be using it for the service. If you are using insurance, providers are not yet required to give a GFE (that part of the law is still waiting for rules), but most hospitals will give an estimate on request, and it is worth asking.

What it must contain

  • Your name and date of birth, and a description of the main service, with its date if scheduled.
  • An itemized list of the services and items reasonably expected, with billing codes and the expected charge for each.
  • The same for other providers and facilities that will be part of the episode, such as the surgeon, anesthesia or the laboratory, where the scheduling provider is coordinating the care.
  • The provider's name, NPI and tax ID, and a statement of your rights, including the dispute process.

The estimate is not a contract, and it is not a maximum; it is a good-faith prediction. But the $400 rule gives it teeth.

When you must receive it

  • If you schedule a service at least 10 business days in advance: within 3 business days of scheduling.
  • If you schedule 3 to 9 business days in advance: within 1 business day.
  • If you request one without scheduling: within 3 business days.

For services scheduled less than 3 business days ahead, no estimate is required, which is why it pays to ask early.

How to ask

"I am self-pay. Please send me a good faith estimate for [procedure] with the codes and charges, including the other providers involved." Ask in writing (patient portal message or email) so there is a record of the date. If the provider says it does not do estimates, cite the No Surprises Act; the requirement applies to every licensed provider and facility, not just hospitals.

Check it against the published price

Take each code on the estimate and look up the hospital's published cash price for it on this site or in the hospital's file. The estimate's facility charge should match the published cash price or be lower. If it is higher, ask for the difference to be explained before the service, and ask whether the published price can be honored. Hospitals do not want a written record of charging above their own published number.

If the bill comes in higher

  1. Get the itemized bill and compare it to the estimate line by line.
  2. If the total billed by that provider is $400 or more above the estimate's total for that provider, you can start the patient-provider dispute resolution process. The window is 120 calendar days from the date on the bill.
  3. File at cms.gov/nosurprises (search "patient-provider dispute"). The fee is $25, refunded if you win. You will need the estimate, the bill and your contact details.
  4. While the dispute is open, the provider cannot send the bill to collections or charge interest.
  5. The reviewer decides whether the extra charges were for things that could not reasonably have been expected. If not, you pay the estimate amount; if so, you pay the billed amount. The decision is binding on the provider.

Practical notes

Each provider's estimate is judged on its own: a hospital and a surgeon are compared separately. Keep every version of the estimate; if the plan changes and the provider updates it, the new one applies. And remember that the estimate is for the expected service; a colonoscopy that finds polyps becomes a different, more expensive code, and the extra can be legitimate. The point of the process is not to freeze prices, it is to stop bills from arriving with no relation to what you were told.

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