Good Faith Estimates under the No Surprises Act

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. If you are insured and using your plan, the plan side of the comparison is covered in estimating your cost with insurance.

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. For how those emergency protections change the urgent care versus emergency room decision, see Urgent care vs ER: where to go and what it costs.

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.

If the estimate is missing, late, or incomplete: work the dates first

A missing estimate is a billing record problem you can document. It is not a reason to guess a price or to fill the gap with a figure from another facility. CMS guidance says information about the availability of a Good Faith Estimate should be found in three places: on the provider or facility website, in the office or on site where patients schedule care or ask about costs, and from the provider in writing or orally when a patient asks about the cost of an item or service. The same guidance says that information must be available in accessible formats and languages. If you asked about cost and none of that information appeared, write that fact down while the conversation is still fresh.

Use a worksheet with only figures and dates you enter yourself. Record the date you scheduled the service or requested the estimate without scheduling, the date and setting of the service, the date any estimate actually arrived, and the name of the convening provider or facility. Then test what you hold against the timing rules above: scheduled at least 3 business days ahead, an estimate due within 1 business day after scheduling; scheduled at least 10 business days ahead, an estimate due within 3 business days; requested without scheduling, an estimate due within 3 business days of the request. If the dates do not line up, say so in one written sentence to the billing office, naming the scheduling date, the due date under that rule, and the arrival date. Keep a copy of that note with the estimate folder.

Check two completeness points that are easy to miss. First, CMS guidance says the estimate should also list items and services that the convening provider or facility expects will need separate scheduling, before or after the period of care for the main item or service. A separate lab visit or a follow up item that needs its own booking belongs on that list, not as a surprise line later. Second, you can ask for the estimate to be explained orally, in person or by phone, and the written estimate still has to follow. The estimate itself is not a bill and it is not a contract. It shows the items and services reasonably expected for your health care needs, based on information known when it was created, and it does not include unknown or unexpected costs that arise during care. If the estimate still does not arrive, do not invent a substitute figure. Ask in writing once more, keep the request, and then use the CMS No Surprises consumer pages or the No Surprises Help Desk at 1-800-985-3059 for the current contact route and next step.

Source: Centers for Medicare and Medicaid Services, Understanding the Good Faith Estimate and Patient-Provider Dispute Resolution Process, February 2022, checked October 22, 2026.

When the estimate must be updated

The first estimate is not the last word if the plan changes before the service date. The convening provider or facility must give you a new Good Faith Estimate when it expects, or is notified of, a change to the scope of the original estimate. Scope means more than the total. It includes the expected charges, the items and services themselves, their frequency, how often they recur, how long they last, and which providers or facilities will furnish them. A change that comes from a co-provider or co-facility, for example anesthesia or pathology added to a procedure, counts in the same way as a change made by the convening provider itself.

The timing is specific. The new estimate must reach you no later than 1 business day before the items or services are scheduled to be furnished. When it is delivered, the provider or facility must also communicate the changes to you, to help you understand what has changed between the initial estimate and the new one. That explanation is part of the protection, not a courtesy extra. Read it line by line: which code was added, removed, or replaced, which billing layer moved, and what charge changed with it. If the explanation names a change but the lines do not show it, ask for that line to be corrected before service.

Recurring care follows the same rule in a longer form. A provider may issue a single estimate for recurring items or services, such as a series of visits over time, instead of a new estimate for every instance. That single estimate must state the expected scope clearly, including the timeframes, the frequency, and the total number of recurring items or services. Its scope must not exceed 12 months. If more recurrences are expected beyond 12 months, a new estimate is required. Keep the start date of a recurring estimate with the document itself, so the 12 month limit can be checked without guessing.

Not every change can be handled this way in advance. Items or services that could not reasonably have been expected, and that arise during a visit, do not have to be listed in the estimate beforehand. That is different from a change the provider already expects, or has been told about, before the service date. The first belongs in a conversation after the visit, with the reason recorded. The second belongs in a new estimate before the visit. When you are told the plan has changed, ask one question in writing: "Please send my updated Good Faith Estimate, and show what changed from the first one." Save both versions, with the dates you received them, and bring both to any later billing conversation. Keep both for at least 1 year after the date of service, so the pair can still be compared with the final bill after any corrected bills settle.

Source: Centers for Medicare and Medicaid Services and U.S. Department of Health and Human Services, FAQs About Consolidated Appropriations Act, 2021 Implementation - Good Faith Estimates for Uninsured (or Self-Pay) Individuals, Part 2, April 5, 2022, checked October 14, 2026.

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. The Good Faith Estimate checker runs this comparison for you: enter one provider's estimate lines and bill lines, and it totals both, flags the changed lines, and applies the $400 test. 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

1. State clearly: "I am uninsured" or "I will be self-pay for this service and will not submit it to insurance."
2. Give the CPT code and setting and ask: "Please provide my Good Faith Estimate in writing, listing professional, facility, anesthesia, and pathology separately."
3. Ask who the convening provider is when more than one provider will bill.
4. 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. For the full no-insurance worksheet that runs code, anchor, cash price, estimate, and setting comparison in one order, see How to price a procedure without insurance.

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.

A scheduled birth is a good test of the estimate rules, because it has several layers to account for; the birth bill guide lists them so an estimate can be read line by line.

The estimate rules in this guide are for people who do not use insurance. For people who do, the protections run the other way and are set out in the guide to No Surprises Act protections for insured patients, including the separate notice and consent form that a nonparticipating clinician must use. A planned admission without insurance is where an estimate matters most, and the hospital stay guide lists what to ask for.

Good Faith Estimate questions

Where the estimate rules come from

Centers for Medicare and Medicaid Services, Medical bill rights and Good Faith Estimate guidance for people who do not have or do not use insurance, CMS No Surprises Act consumer pages, checked October 14, 2026. Centers for Medicare and Medicaid Services, FAQs About Consolidated Appropriations Act, 2021 Implementation - Good Faith Estimates for Uninsured (or Self-Pay) Individuals, Part 2, April 5, 2022, checked October 14, 2026. Centers for Medicare and Medicaid Services, Understanding the Good Faith Estimate and Patient-Provider Dispute Resolution Process, February 2022, checked October 22, 2026.