Patient Playbook - Guide 2
Good Faith Estimates under the No Surprises Act
If you are uninsured or you choose to pay without using insurance, federal law gives you the right to a Good Faith Estimate before a scheduled service. This guide explains the money mechanics only. It is not legal or medical advice.
Confirm your price in writing before service. A Good Faith Estimate is the written form of that rule for uninsured and self-pay patients.
Who this covers
The Good Faith Estimate requirement applies when you are uninsured or when you tell the provider you will not use insurance for the service (self-pay). It applies to most health care providers and facilities, including hospitals, surgery centers, imaging centers, and clinician offices, for items and services they expect to provide.
Separate surprise-billing protections in the No Surprises Act also limit out-of-network cost-sharing for emergency care and for certain non-emergency care at in-network facilities. Those protections are about insurance cost-sharing, not cash quotes. This guide focuses on the estimate you can request before a scheduled, shoppable service.
When you get the estimate
- When you schedule a service at least 3 business days in advance, the provider should give the estimate within 1 business day after scheduling.
- When you schedule at least 10 business days in advance, the estimate should be given within 3 business days after scheduling.
- When you ask for an estimate without scheduling, it should be given within 3 business days of the request.
Co-providers and co-facilities that are part of the same episode (for example the facility and the clinician, or anesthesia and pathology for an endoscopy) should be reflected through the convening provider or facility that coordinates the estimate.
What the estimate should list
| Element | Why it matters |
|---|---|
| Patient and provider identification | Names, contact information, and the provider tax identification where required |
| Description and codes | Each item or service with its CPT or other code, so the estimate matches the bill |
| Expected charges by provider | Professional, facility, anesthesia, and pathology listed separately when they bill separately |
| Service location | The setting where each item will be furnished |
| Disclaimers and next steps | That actual charges may differ if the plan changes, and how to dispute |
If a line is missing, ask for a revised estimate that lists it. An estimate that names only the facility portion is incomplete for a procedure that also has a professional, anesthesia, or pathology bill.
The $400 dispute rule
If your final bill from a provider or facility is $400 or more above that provider's Good Faith Estimate for the same items and services, you may be eligible to start the federal patient-provider dispute resolution process. You generally must start the process within 120 calendar days of receiving the bill. Keep the estimate, the bill, and any revised estimates together. The estimate does not freeze the price when the clinical plan legitimately changes on the day - for example when a biopsy is taken - but the changed code and charge should be explainable against the estimate's listed items.
This summary is general information. For the current rules, forms, and deadlines, check the CMS No Surprises Act pages and, if needed, a qualified advisor. MyCarePrice does not file disputes on your behalf.
How to ask
- State clearly: "I am uninsured" or "I will be self-pay for this service and will not submit it to insurance."
- Give the CPT code and setting and ask: "Please provide my Good Faith Estimate in writing, listing professional, facility, anesthesia, and pathology separately."
- Ask who the convening provider is when more than one provider will bill.
- Save the estimate with the date you received it. Bring it to the billing conversation if the final bill differs.
How this relates to a cash quote
A cash quote you negotiate by phone and a Good Faith Estimate serve the same purpose: a written price before service. If you are uninsured or self-pay, ask that the written cash price be provided as your Good Faith Estimate so the $400 dispute protection attaches. Either way, confirm your price in writing before service.
How to use the estimate with the anchors on this site
When the estimate arrives, check it in three passes. First, match every code on the estimate to the code on your order and to the procedure page for that test. A code you do not recognize is a question to ask before service, not after the bill. Second, match every billing layer: professional, facility, anesthesia, and pathology should each be listed, marked as not applicable, or explained. Third, compare the order of magnitude with the verified Medicare anchor for that code. The anchor is not your price, but a facility layer many times the anchor is a prompt to ask what the payment system and inclusions are. The Price Anchor Explorer makes that third pass quick.
Keep the estimate, any revised estimate, and the final bill together. If the bill exceeds the estimate, the dispute question is specific: is it $400 or more above the estimate from that provider for the same items and services, and are you inside the filing window? Write those dates down the day the bill arrives. Prices only, no legal advice - for the current rules and forms, use the CMS No Surprises Act pages or a qualified advisor.
Frequently asked questions
Is a Good Faith Estimate a guaranteed final price?
No. It is a good faith listing of expected items, codes, and charges. If the clinical plan legitimately changes, charges can change. Keep any revised estimate and ask for the changed code and charge to be explained against the original.
When can I dispute a bill against the estimate?
If the final bill from a provider or facility is $400 or more above that provider's Good Faith Estimate for the same items and services, you may be eligible for the federal patient-provider dispute process. You generally start within 120 calendar days of the bill. Check current CMS rules for forms and deadlines.
Does the estimate cover every provider who will bill me?
It should reflect co-providers and co-facilities in the episode through the convening provider or facility. Ask who that convening provider is and whether anesthesia and pathology are listed when they apply.
How is this different from a cash quote?
A phone cash quote is a price conversation. A Good Faith Estimate is the written form for uninsured and self-pay patients, and the $400 dispute protection attaches to it. Ask for the written cash price as your Good Faith Estimate.
Next: Questions to ask billing before your procedure (checklist) - How to ask for the cash price.