What a good faith estimate is
A Good Faith Estimate (GFE) is a written list of expected charges for specific health care items and services. It is not a bill—it is a upfront price quote so patients can plan and compare before agreeing to care.
Under the federal No Surprises Act, most hospitals, doctors, and other providers must give uninsured and self-pay patients a good faith estimate in certain situations. If the final bill from that provider is much higher than the estimate, you may have a federal patient-provider dispute resolution (PPDR) path—not the same process as surprise billing for insured patients (see Surprise Medical Bills).
This guide is for patients and beginning advocates helping someone without insurance or choosing not to use insurance for scheduled care.
Who can get one
You are generally entitled to a good faith estimate when (CMS — Know your rights without insurance):
- You do not have health insurance, or
- You have insurance but choose not to use it for this care (self-pay), and you tell the provider that in advance
Care must be on or after January 1, 2022. If you are using insurance and want the plan to pay, this GFE dispute process usually does not apply—use appeals and EOB comparison instead (Medical Bill vs. EOB).
Providers must usually give an estimate when you schedule care at least 3 business days (Monday–Friday) in advance, or when you ask for one. Same-day or urgent scheduling rules differ; ask the office what applies.
What the estimate should include
A good faith estimate should identify the patient, provider or facility, expected items and services, and expected charges. For planned care involving multiple places (hospital plus surgeon plus anesthesia), you may receive separate estimates from each provider or facility—each party estimates its own portion.
The estimate should list enough detail to compare later to an itemized bill: dates, descriptions, and dollar amounts. Keep the original in your file. You need the written estimate to use the federal dispute process if the bill exceeds it by $400 or more.
Insured patients who ask for pricing may receive different notices (including, in some cases, an Advanced Explanation of Benefits from the plan). That is separate from the uninsured/self-pay GFE dispute path.
How to request an estimate
When scheduling care, say clearly that you are uninsured or self-payand want a written estimate of expected charges. You do not need to use the exact words "good faith estimate"—ask for expected costs in writing before you agree to the service (CMS).
If you scheduled at least three business days ahead and did not receive an estimate, follow up in writing (email, portal message, or letter). For any planned expensive service—surgery, imaging, colonoscopy, delivery— request estimates from the facility and each professional who will bill separately.
Sample requests and dispute letters may appear under Billing Letter Templates when available.
Compare the estimate to your bill
When the bill arrives, compare it to the good faith estimate from the same provider or facility, not a combined guess across everyone who treated you. Use an itemized bill so you can match line items.
Ask:
- Is this bill from the same provider who signed the estimate?
- Do the services on the bill match what was estimated?
- Is the total at least $400 higher than that provider's estimate?
Extra services not on the estimate may explain some increase—but a large unexplained gap may qualify for dispute or negotiation. See Coding, Charges & Allowed Amounts for vocabulary on charges vs. adjustments (mostly relevant when insurance is involved).
Dispute a bill that exceeds the estimate
When you can use federal dispute
You may be eligible for patient-provider dispute resolution when (CMS — Dispute a medical bill):
- You were uninsured or self-pay and told the provider you were not using insurance
- You have a good faith estimate from that provider or facility (received at least 3 business days before the appointment when scheduled ahead)
- You have an initial bill dated within the last 120 calendar days (about four months)
- That provider's or facility's bill is at least $400 above their good faith estimate (the threshold applies per provider/facility, not added across all providers)
Example: Hospital estimate $5,000, hospital bill $5,500—only $500 over, but meets $400 threshold for that hospital. Surgeon estimate $2,000, surgeon bill $2,300—$300 over, does not meet threshold for surgeon even if combined totals look worse.
Steps to start a dispute
- Call the provider first. Say the bill exceeds the good faith estimate by $400 or more. Ask them to lower the bill to the estimate, negotiate, or discuss financial assistance.
- Gather documents: good faith estimate, itemized bill, payment records, correspondence.
- Start federal dispute within 120 days of the date on the initial bill. CMS explains the process at Dispute a medical bill.
- Pay the $25 administrative fee to open the dispute (required to start). If the independent reviewer decides in your favor, that fee is deducted from what you owe; if not, you may owe the higher amount per the decision.
An independent dispute resolution entity reviews the estimate, bill, and records, then decides whether you pay the estimated amount, the billed amount, or something in between. Outcomes depend on the specific facts CMS publishes in its process materials.
While a dispute is open
Federal rules restrict certain collection actions while patient-provider dispute resolution is pending for eligible bills. Document when you filed. If collections contacts you, note the open dispute in writing. See Collections, Credit & Medical Debt.
If you never received an estimate
You cannot use the federal GFE dispute process without a written estimate from that provider. You still can:
- Negotiate and request itemization per the Billing Dispute Roadmap
- Apply for hospital financial assistance or charity care
- File a complaint with the No Surprises Help Desk (1-800-985-3059) if a required estimate was never provided
Scenarios beginners run into
Scheduled surgery without insurance
Patient schedules knee surgery self-pay; hospital sends GFE for $12,000. After surgery, hospital bills $18,000. Difference is $6,000—above $400 threshold for the hospital. Advocate compares itemized bill to GFE line by line, calls billing, then starts CMS dispute within 120 days if unresolved. Separate surgeon and anesthesia bills are compared to their own estimates.
Several providers, one bill too high
Total care felt twice as expensive as expected, but each individual provider's bill is only $250 above its estimate. Federal PPDR may not apply to any single provider even though the patient is struggling overall. Pivot to negotiation, payment plans, and financial assistance—not the $400-per-provider dispute rule.
Using insurance—not a GFE case
Patient has Marketplace insurance and the claim was submitted to the plan. A good faith estimate dispute is the wrong tool. Compare bill to EOB, use insurance appeals if denied, and use surprise billing rules if out-of-network—not GFE PPDR.
Bill higher but under $400 threshold
Estimate $1,200, bill $1,450—patient is upset but $250 below federal dispute threshold. Still dispute errors with billing, negotiate, and ask for financial assistance. Document whether extra services were performed without consent or omitted from the estimate.
Related guides
- Surprise Medical Bills — insured patients and balance billing
- Requesting an Itemized Bill
- Hospital Financial Assistance
- Negotiating Medical Bills
- Billing Dispute Roadmap