A price projection before a procedure could help you avoid large medical debt. Just like an estimate on a car repair helps you plan financially, so would an estimate on a surgical procedure. This is especially important if you don’t have insurance or plan to self-pay your medical bills.
Fortunately, a law exists to protect you from medical bill surprises: the No Surprises Act of 2022. According to the Centers for Medicare and Medicaid Services (CMS), it allows you to receive a good faith estimate on the cost of any procedures. It also requires that the estimate be legitimate.
Good Faith Estimate Charges for Medical Care
The No Surprises Act requires healthcare providers and facilities to provide good faith estimates of charges to uninsured or self-pay patients. It also created a patient-provider dispute resolution (PPDR) process, allowing the patient to contest charges that were substantially in excess of the good faith estimate.
Who Qualifies for a Good Faith Estimate?
According to CMS, the rule applies to uninsured patients and self-pay patients. Self-pay patients could be those with insurance who choose not to use it.
If you wish to self-pay, you must tell your provider that you won’t be using health insurance to pay for the service.
Insured patients using their insurance are supposed to receive an advance explanation of benefits from their insurer instead of a good faith estimate under the No Surprises Act. However, full implementation of the advance explanation of benefits requirement has been delayed, according to CMS.
If you are going to use your insurance, you are not entitled to a good faith estimate from the provider or facility. You must instead ask your insurer for a coverage estimate.
Good Faith Estimate, Not a Bill
According to CMS, a good faith estimate is not a bill. It lists expected charges for items or services based on information known at the time. As such, it will not include unknown or unexpected costs that may be added during your treatment.
Typically, it must include expected charges for the primary service and any other items or services that are reasonably expected to be part of the care.
The good faith estimate may not include every item or service you receive from the healthcare provider or facility.
For example, if you’re scheduled for surgery, the good faith estimate may include standard costs like:
· Surgery
· Anesthesia
· Lab services
· Tests
However, medical items related to the surgery but scheduled separately may not be included in the good faith estimate. These could include physical therapy or pre-surgery appointments.
You should receive an additional good faith estimate when you schedule these extra items.
The Good Faith Estimate’s $400 Rule
If your final bill exceeds the total good faith estimate by $400 or more, you may be eligible to file a federal PPDR, according to CMS. This applies to the bill total, not individual line items.
You have 120 calendar days from the date on the initial bill to file a dispute.
The provider doesn’t handle the dispute; instead, it is reviewed by an independent third party. There is a $25 non-refundable administrative fee. If you win the dispute, the $25 will be deducted from the amount you owe your provider. The third-party reviewer’s decision is binding, and if you win, the provider must adjust the bill.
Filing a PPDR
This is not a confrontational process. Start by requesting an itemized bill. Place it side by side with your GFE and check the service codes, descriptions, and charges.
Determine the difference between the two. Even if individual items differ in both directions, it applies to the total.
You’ll need your original GFE, the final bill, and any correspondence from the provider about the charges. Provide your contact information and date of service.
Submit your dispute through the CMS Patient Provider Dispute Resolution portal.
Good Faith Estimate Deadline
According to CMS, you must receive a good faith estimate after you schedule a healthcare item or service.
If you schedule a service or item three to nine business days in advance, you must receive the good faith estimate no later than one business day after scheduling. The provider or facility has three business days to provide a good faith estimate if you schedule 10 or more business days before the service or item is performed.
What Information Is Included on a Good Faith Estimate?
According to the CMS regulatory requirement (45 CFR 149.610(c)), the good faith estimate must be available in the patient’s spoken language. Other items needed on a good faith estimate include the patient’s name and birth date. A concise explanation of services must be provided in an easy-to-comprehend language.
Any additional items or services offered alongside the primary services must be itemized, and diagnostic codes, service codes, and expected costs of each item or service must be listed.
The healthcare providers and facility must also appear.
A disclaimer stating this is an estimate, and that exact costs might differ, must be provided. The patient must be informed that they have the right to dispute charges if the actual bill substantially exceeds the good faith estimate.
The patient must be made aware that the good faith estimate is not a contract and doesn’t require them to accept the service or items.
The Epoch Times copyright © 2026. The views and opinions expressed are those of the authors. They are meant for general informational purposes only and should not be construed or interpreted as a recommendation or solicitation. The Epoch Times does not provide investment, tax, legal, financial planning, estate planning, or any other personal finance advice. The Epoch Times holds no liability for the accuracy or timeliness of the information provided.
