Good Faith Estimate

A Good Faith Estimate is a written cost estimate that providers are required to give uninsured and self-pay patients before scheduled care under the No Surprises Act. It must include all expected charges — facility, professional fees, anesthesia, labs — from the primary provider and from any co-providers involved in the episode. The estimate must be provided at least three business days before a scheduled service (or one business day for services scheduled within three to ten days).

The teeth in the rule is the dispute process. If the final bill exceeds the Good Faith Estimate by more than $400 for any single provider, the patient can dispute the excess through a federal patient-provider dispute resolution process. The provider bears the burden of justifying the higher bill. Most providers now have a process to generate GFEs, though quality varies — some are line-item detailed, others are one-page summaries. The GFE requirement currently applies to uninsured and self-pay patients only; a parallel requirement for insured patients (the Advanced EOB) has been delayed by CMS but is still in the rules.

The takeaway: if you're paying cash or uninsured for scheduled care, request the Good Faith Estimate in writing before the appointment. Save it. If the bill comes in more than $400 higher, dispute it through the federal process at cms.gov/nosurprises.