Good Faith Estimate: Your Right to a Price Before Care
Last updated September 10, 2026.
If you have no insurance or choose not to use it, federal law requires providers to give you a written estimate of costs before scheduled care. This estimate must cover expected charges from all providers involved. If your final bill is $400 or more over the estimate, you can dispute it.
Who can request a good faith estimate
You qualify if you have no health insurance or if you decide not to file a claim with your insurer. This includes people on short-term plans, health-sharing ministries, and those paying cash by choice.
The rule applies to scheduled care: appointments, procedures, or services booked at least one business day in advance. Emergency care and walk-in visits do not require an estimate.
Providers must give you an estimate whether you ask or not, but it helps to request one in writing when you book. This includes doctors, hospitals, surgery centers, labs, and therapists.
How to request your estimate
Call or email the office when you schedule your appointment. Say you are uninsured or self-pay and want a good faith estimate in writing. Ask for it at least three business days before your visit.
The estimate should arrive within one business day for appointments scheduled at least three days out, or within three business days for appointments scheduled 10 or more days ahead. If it does not arrive, follow up.
For telehealth or online scheduling, select the self-pay option and note that you need the estimate. Keep a record of your request, including the date and the person you spoke with.
What the estimate must include
The document lists expected charges for the primary service and any related services during the same period of care. This includes the provider you booked with and any other providers who may bill separately, such as anesthesiologists or labs.
You will see a diagnosis code or description, expected service codes, and the cost for each. The estimate also includes the provider's name, contact information, and a disclaimer that the final cost may differ.
The period of care usually means services within 30 days or a single treatment episode. For recurring services like physical therapy, the estimate should cover the expected number of visits.
When the final bill exceeds the estimate
If your bill is $400 or more higher than the good faith estimate, you can dispute it through a federal process. The dispute is free and handled by an independent reviewer.
You have 120 days from the date on the bill to file. Submit your dispute to the federal patient-provider dispute resolution portal. Include your estimate, the bill, and a brief explanation of the difference.
The reviewer will decide if the bill was reasonable. If the estimate was accurate and the provider did not inform you of changes, the bill may be reduced. If the care changed for medical reasons, the higher bill may stand.
Common problems and how to handle them
Some offices do not send the estimate or claim they do not have to. If this happens, cite the No Surprises Act and request it in writing. If they refuse, contact the federal complaint line at 1-800-985-3059.
The estimate may leave out charges from other providers, such as an imaging center or specialist. Ask the primary office who else will bill you and request estimates from those providers as well.
If the bill comes from a provider not listed in the estimate, you can dispute that charge separately. The original estimate should have included all expected providers for that period of care.
Using the estimate to plan care
Compare estimates from different providers if you have the option. Prices vary widely, and a written estimate lets you shop. Call at least two offices for the same service and ask for the total expected cost.
If the estimate is too high, ask about payment plans or financial assistance before you schedule. Some clinics offer sliding-scale fees or charity care for uninsured patients.
Keep the estimate with your other medical records. If you need to dispute a bill or apply for financial help later, the estimate shows what you were told to expect.
Common questions
Do I get a good faith estimate if I have insurance?
No, the good faith estimate rule applies only to uninsured patients and those choosing not to use insurance. If you have coverage, your insurer provides cost estimates through their tools, and surprise billing protections apply separately.
What happens if I never received an estimate before my appointment?
The provider was required to give you one. If your bill is $400 or more over what you expected, you can still file a dispute. Note in your dispute that you never received an estimate and include any cost information you were given verbally.
Can I get an estimate for emergency care?
No, emergency care does not require a good faith estimate because it is not scheduled in advance. After emergency care, you can request an itemized bill and ask about financial assistance or payment plans.
How long does the dispute process take?
The independent reviewer typically issues a decision within 30 days of receiving all required documents. Both you and the provider can submit additional information during the review. The decision is binding.
Does the estimate guarantee I will not be charged more?
No, it is an estimate based on expected care. Your final bill can be higher if your condition requires additional services or if complications arise. You can dispute the bill only if it exceeds the estimate by $400 or more and the provider did not inform you of changes.
Sources
Pymander is not a replacement for a physician and does not provide medical advice, diagnosis, or treatment.