Good Faith Estimate for Medical Bills

A Good Faith Estimate (GFE) is a written estimate of the total expected cost for a scheduled medical service or set of services. It must include charges from every provider involved in your care — not just the primary doctor or facility, but also anesthesiologists, labs, imaging centers, and any other providers who are expected to be part of your treatment. The estimate must be provided in a format that is easy to understand, with itemized costs for each service. It is not a final bill — actual charges may vary based on what happens during treatment — but it establishes a baseline that triggers legal protections if the final bill significantly exceeds it.

The Good Faith Estimate requirement currently applies most directly to uninsured and self-pay patients. If you do not have health insurance, or if you choose not to use your insurance for a particular service, every healthcare provider and facility must give you a GFE. This includes hospitals, surgery centers, physician offices, labs, imaging centers, and any other provider involved in your scheduled care. Insured patients also benefit from related transparency provisions, and many providers will offer estimates to insured patients upon request even where not strictly required. The Department of Health and Human Services has indicated plans to extend full GFE requirements to insured patients in future rulemaking, so this right is expected to expand.

You can request a Good Faith Estimate in several ways:

• —When scheduling a service: The provider is required to inform you of your right to a GFE and provide one automatically if you are uninsured or self-pay
• —By phone or in writing: Call the provider's billing department and explicitly request a Good Faith Estimate for the services you are scheduling
• —At any time before service: You can request a GFE for any scheduled service at least 3 business days before the appointment

The provider must deliver the estimate within 1 business day if the service is scheduled at least 3 days out, or within 3 business days if the service is scheduled 10 or more days out. If a provider refuses to provide a GFE, they are violating federal law — you can report them to the Department of Health and Human Services at 1-800-985-3059.

A compliant Good Faith Estimate is not a vague ballpark — it must contain specific, detailed information:

• —Patient name and date of birth
• —Description of each scheduled item or service, including the relevant procedure code (CPT/HCPCS)
• —Expected charges for each item or service, listed separately
• —Name and NPI (National Provider Identifier) for each provider or facility expected to provide services
• —Diagnosis codes (ICD-10) if applicable
• —A disclaimer that the actual charges may differ and explaining the patient's right to dispute

The GFE must cover all reasonably expected services — not just what the primary provider charges, but also ancillary services like anesthesia, lab work, and pathology that are a standard part of the scheduled procedure. If a provider is listed on the GFE, they are bound by the estimate's protections.

If your final bill is $400 or more above your Good Faith Estimate ¹, you have the right to initiate a formal dispute through the Patient-Provider Dispute Resolution (PPDR) process established by the No Surprises Act. Here is how it works:

• —File a dispute within 120 days of receiving the bill by contacting the dispute resolution entity designated by HHS
• —Provide your Good Faith Estimate and the final bill as documentation
• —The dispute resolution entity will review both and make a binding determination within 30 business days
• —During the dispute, the provider cannot send the bill to collections or take adverse action against you

The $400 threshold ¹ is the key number to remember. If the bill exceeds your estimate by less than $400, the formal dispute process does not apply — though you can still negotiate directly with the provider. Upload your bill to ORVO to compare the charges against fair market pricing and strengthen any negotiation.

The Good Faith Estimate is one pillar of the broader No Surprises Act, which took effect in January 2022 ². While the No Surprises Act is best known for banning surprise out-of-network bills in emergency situations, the GFE provision addresses a different problem: the lack of price transparency for scheduled care. Together, these provisions create a framework where patients can know costs before treatment and have legal recourse if actual charges are unreasonable. The GFE requirement works alongside hospital price transparency rules that require facilities to publish their prices publicly. Use both tools together — check published prices before your appointment, request a GFE, and then compare your final bill against both the estimate and market rates.

A Good Faith Estimate is only useful if you treat it as an active tool, not a passive document. Here is how to maximize its value:

• —Request the GFE in writing and save a copy — you will need it if you dispute later
• —Ask about services that might not be included, such as post-operative care, follow-up visits, or unexpected findings that could lead to additional procedures
• —Compare the GFE against ORVO market data to see if the estimated prices are in line with what other facilities charge for the same procedure codes
• —Ask the provider what could cause the final bill to exceed the estimate — understanding the variables helps you evaluate the estimate's accuracy
• —Get GFEs from multiple providers for the same procedure and use them to negotiate — providers are more willing to match or beat a competitor's published estimate
• —Keep the GFE with your medical records for at least one year after the service date, in case you need it for a dispute