What Is a Good Faith Estimate?
What a Good Faith Estimate Includes — and What It Leaves Out
Key Takeaway: CMS describes a good faith estimate as a list of expected charges before you receive items or services from one provider or facility. It is not a bill. Ask each clinician and the facility for their own estimate.
CMS's good faith estimate guide says the estimate should include expected charges for the scheduled items and services, including facility fees, hospital fees, and room and board from that provider or facility. It must include an itemized list with expected charges and be given in the way you prefer — printed or emailed. A provider may discuss it by phone or in person if you ask.
CMS currently states that a good faith estimate lists expected charges for a single provider or facility. For surgery, CMS's example is to request two estimates: one from the surgeon and one from the hospital. The estimate might not include care scheduled separately (for example later physical therapy), items another provider will furnish, or extra services the clinician did not anticipate.
CMS's page on rights when you are not using insurance repeats that you are given a good faith estimate only if you do not have insurance or are not using it for that care, and that you will not get this estimate during emergency care.
When Must the Provider Give Me the Estimate?
Key Takeaway: You are generally entitled to a good faith estimate if you schedule at least three business days ahead, or if you ask for one without scheduling. CMS publishes shorter turnaround times when you book further in advance. Booking fewer than three business days ahead does not create this entitlement for that booking.
| When you ask or schedule | CMS timing |
|---|---|
| Schedule 0–2 business days ahead | CMS says you are not entitled to this estimate for that booking |
| Schedule 3–9 business days ahead | Estimate within 1 business day of scheduling |
| Schedule 10 or more business days ahead | Estimate within 3 business days of scheduling |
| Request an estimate without scheduling | Estimate within 3 business days of the request |
CMS's no-insurance page counts business days as Monday through Friday. If you scheduled care and have not received a written estimate, ask for one. CMS says you do not have to use the words “good faith.”
Who Is Entitled to a Good Faith Estimate?
Key Takeaway: Uninsured people and people who have coverage but choose not to use it for that service. Tell the provider in advance that you are not using insurance. People using a plan, Medicare, or Medicaid for the visit generally receive plan or program estimates and EOBs later — not this self-pay notice.
CMS's no-insurance page applies to people in the United States who do not have health insurance or are not using it. You might choose self-pay if the service is not covered or if paying out of pocket costs less than using the plan. If you are using insurance, you generally get a plan cost-sharing estimate or an Explanation of Benefits after the claim processes — a different document from this self-pay notice. Insured cost-sharing is calculated on the plan's allowed amount, not on a good faith estimate.
Bill Higher Than the Estimate — or a Surprise OON Bill?
AppealFlow drafts No Surprises Act and billing-dispute letters from the facts you enter. You still file patient-provider dispute resolution or a CMS complaint through the federal process.
What If the Final Bill Is $400 or More Above the Estimate?
Key Takeaway: If you are uninsured or self-pay, you received a written good faith estimate, and any provider or facility bills at least $400 more than that estimate, CMS's patient-provider dispute resolution process is the federal path. You generally cannot use that process without the written estimate.
CMS's no-insurance page states you can dispute a bill if one of your providers or facilities charged at least $400 more than their estimate. An independent third party reviews the bill. CMS says you have to start a dispute within 120 days (about four months) of getting your initial bill.
The federal patient-provider dispute resolution process is the filing path CMS describes for that $400-over dispute. CMS has published an administrative fee of $25 for the federal process. Confirm the current fee on the CMS page before you file — published amounts can change.
If you never received an estimate and you think you should have, CMS says to ask for one in writing and that you can submit a complaint. Filing a complaint does not stop the bill. Keep the estimate; CMS says you will need it if you dispute later.
Is a Good Faith Estimate the Same as an Itemized Bill?
Key Takeaway: No. The estimate is a pre-service list of expected charges. An itemized bill is the post-service list of what was actually charged, with CPT or revenue codes. You often need both if you dispute a self-pay bill.
Use the estimate to show whether any one provider or facility crossed the $400-over threshold. Use the itemized bill to see which lines exceeded the estimate. For how to request that statement, see how to get an itemized hospital bill. For negotiation steps after you have the lines, see how to negotiate medical bills.
Weak vs. Strong Wording When the Bill Exceeds the Estimate
Key Takeaway: Attach the written estimate and the bill, name the provider, and state the dollar gap. “This feels high” does not show the $400 threshold CMS uses.
| ❌ Weak Request | ✓ Strong Request |
|---|---|
| “You never told me the price. Take it off.” | “I scheduled [service] on [date], at least three business days ahead / I requested an estimate on [date]. Please send a written good faith estimate for [provider or facility] as described on CMS's good faith estimate guide. I do not need to use the words ‘good faith.’” |
| “The whole hospital stay was more than the surgeon's estimate, so I dispute everything.” | “CMS states a good faith estimate lists expected charges for a single provider or facility. Estimate from [surgeon] is $[X]. Estimate from [hospital] is $[Y]. Bill from [hospital] is $[Z], which is at least $400 above that facility's estimate. I am using patient-provider dispute resolution for [hospital] claim/account #[number].” |
| “I have insurance, so this good-faith-estimate dispute caps my out-of-network ER bill.” | “I used insurance for this visit. The self-pay good faith estimate / PPDR path does not apply. I am reviewing surprise-billing protections for insured out-of-network emergency or facility care on a separate track.” |
How Is This Different From Insured Surprise-Billing Protections?
Key Takeaway: The good faith estimate and patient-provider dispute path are for uninsured or self-pay scheduled care. No Surprises Act limits on insured out-of-network emergency, certain in-network facility, and air ambulance bills are a different track.
CMS's patient-provider dispute page describes both sets of rights. If you use health insurance, the No Surprises Act can limit unexpected out-of-network bills for emergency visits, certain non-emergency care at in-network facilities, and air ambulance. If you do not use insurance, the usual tool is the good faith estimate and, when the bill is at least $400 over that estimate, patient-provider dispute resolution. Do not mix the two packets on one letter.
Do not treat the estimate as a price cap on every bill. CMS notes that unanticipated items may be missing, that each provider issues a separate estimate, and that emergency care does not get this notice. Medicare or Medicaid used as coverage is not the self-pay population this estimate is written for.
Frequently Asked Questions
Who gets a good faith estimate, when it is due, the $400 patient-provider dispute threshold, and how the estimate differs from an itemized bill.
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Disclaimer: This article is for educational purposes only and does not constitute medical, legal, or financial advice. AppealFlow.net is not a healthcare provider, insurance broker, or law firm. Good faith estimate and patient-provider dispute rules are set by CMS — confirm current eligibility, timing, and any administrative fee on CMS.gov before you file. For medical emergencies, call 911. See our full disclaimer.