Short answer: A good faith estimate is a written list of what your care is expected to cost. If you do not use insurance, providers usually must give you one if you ask or schedule care at least 3 business days ahead. If your final bill is $400 or more above it, you may be able to dispute it.
A good faith estimate is a written price estimate from a doctor, clinic or hospital. The Centers for Medicare and Medicaid Services (CMS), the federal agency that explains this rule, says it should include the expected charges for the items and services you will get. It comes from one provider or facility. If a surgeon and a hospital are both involved, you should ask each of them for an estimate. Care that was not expected will not show up on the estimate.
CMS says the rule applies to people who do not have or use health insurance. That includes people who have insurance but choose to pay on their own. If you have no insurance at all, see how to see a doctor without insurance. You will not get an estimate during emergency care. If you have chest pain, trouble breathing, signs of a stroke or another emergency, call 911 and get care first.
You can ask for an estimate at any time, or you will receive one when you schedule care at least 3 business days in advance. Tell the office you are not using insurance when you call. Ask for the estimate in writing. If you are comparing practices, you can find a direct-pay doctor near you and ask each one for a price.
Keep your estimate in a safe place. A photo on your phone works too. When the bill arrives, compare it with the estimate line by line. CMS says you can dispute a bill if it is at least $400 more than that provider's estimate. You need the written estimate to use the dispute process, and an independent third party then reviews the bill and sets an appropriate payment.
CMS also says you have to start a dispute within 120 days, which is about 4 months, of getting your first bill. Do not wait.
The CMS pages linked below explain the dispute process, how to check whether you qualify, and how to find a patient advocate. CMS lists a phone line at 1-800-985-3059 for questions and complaints, and says you can submit a complaint if you believe a provider is not following these rules.
CMS says you have to start a dispute within 120 days, about 4 months, of getting your first bill. You need the written estimate.
No. CMS says you will not get an estimate during emergency care. Call 911 in an emergency.
CMS lists 1-800-985-3059 for questions and complaints about these rules.
