Good Faith Estimates: Your Right to Know Costs Before Care

If you don't have health insurance, or you choose not to use it for a particular visit, you have a legal right to know roughly what your care will cost before you get it. Under the federal No Surprises Act, providers and facilities must give uninsured and self-pay patients a written Good Faith Estimate. And if the final bill comes in far above that estimate, there is a formal process to dispute it.

Here is how Good Faith Estimates work and how to use them to protect yourself.

Who Has the Right to a Good Faith Estimate

The protection applies to patients who are uninsured, and to insured patients who tell the provider they plan to pay out of pocket instead of billing their insurance. It covers scheduled care, such as a planned surgery, imaging, or a series of therapy sessions, and it applies when you simply ask a provider about the cost of a service.

You don't need to know the law or use any special wording. Providers are required to tell self-pay patients that estimates are available, typically through notices posted in the office, on their website, and when you schedule.

When You Should Receive It

The rules set clear timelines:

• Scheduled at least 3 business days ahead: You should receive the estimate within 1 business day of scheduling.

• Scheduled at least 10 business days ahead: You should receive it within 3 business days of scheduling.

• If you ask for one: You should receive it within 3 business days of your request.

The estimate must be in writing. It can be delivered on paper or electronically, whichever you prefer.

What a Good Faith Estimate Must Include

A complete estimate should list:

• Your name and date of birth

• A description of the primary service and the date it is scheduled, if known

• An itemized list of the items and services reasonably expected, grouped by provider or facility, with expected charges for each

• Diagnosis codes and service codes where applicable

• The names and contact details of the providers and facilities involved

• A list of any items or services that will require a separate estimate

• A statement explaining your right to dispute the bill if charges are substantially higher than the estimate

One important detail: the rules call for the scheduling provider to coordinate an estimate that also covers other providers expected to be part of your care, such as the anesthesiologist for a surgery. In practice, some of these co-provider requirements have been phased in slowly, so if your estimate seems to leave someone out, ask whether separate estimates are coming.

When the Bill Is Much Higher: The $400 Rule

If your final bill from any single provider or facility is at least $400 more than that provider's Good Faith Estimate, you can start the federal Patient-Provider Dispute Resolution process.

• Deadline: You must start the dispute within 120 calendar days of the date on the initial bill.

• Fee: There is a small administrative fee, currently $25.

• Who decides: An independent, certified dispute resolution entity reviews the estimate, the bill, and any explanation from the provider.

The reviewer decides what you owe. If the provider can't show that the extra charges came from something new and medically necessary that couldn't reasonably have been foreseen, you'll generally be held to the estimated amount. While a dispute is open, the provider shouldn't send the bill to collections or charge late fees on the disputed amount.

How to Start a Dispute

• Gather your documents: Keep the Good Faith Estimate and the bill, and make sure the dates and services match.

• Contact the provider first: Many billing offices will adjust the bill once they see it exceeds their own estimate. Ask in writing.

• File with the federal program: If the provider won't fix it, start the process through the No Surprises Act resources at CMS.gov, or call the No Surprises Help Desk at 1-800-985-3059.

• Watch the calendar: The 120-day window starts on the bill date, not when you open the envelope.

Tips for Getting the Most From Your Estimate

• Always say "self-pay" up front: If you're uninsured or not using insurance, say so when you schedule and ask for a Good Faith Estimate in writing.

• Ask questions before you agree: If a line is unclear, ask what it is and whether it's necessary. Ask whether the provider offers a cash-pay discount or payment plan.

• Compare providers: Estimates let you shop. Imaging, lab work, and outpatient procedures can vary widely in price across Texas facilities.

• Keep everything: Save the estimate, any updated estimates, and your final bill together. Without the estimate, you can't use the dispute process.

If You Have Insurance

Good Faith Estimates and the $400 dispute process are designed for uninsured and self-pay patients. If you're using insurance, different No Surprises Act protections apply, mainly limits on surprise out-of-network bills for emergency care and for certain services at in-network facilities. Texas law adds its own protections for state-regulated plans, explained in our guide to Texas SB 1264.

The Bottom Line

If you're paying out of pocket, never schedule care without asking for a Good Faith Estimate in writing. It gives you a clear price before treatment, a tool for comparing providers, and a legal basis to challenge a bill that comes in $400 or more above what you were told.