Good Faith Estimates: Your Right to Know Healthcare Costs in Advance

Your Rights:

• Any healthcare provider must give you a written Good Faith Estimate of expected charges BEFORE you receive care
• You should receive it when you schedule a service, or when you ask for one
• The estimate must include charges for all related items and services, including co-providers

What Must Be Included:

• Expected charges for all providers involved in your care
• Facility fees (hospital, surgery center, etc.)
• Associated services like lab work, imaging, anesthesia
• Any reasonably expected follow-up care within the same practice

Timeline Requirements:

• For services scheduled 3+ days out: providers must give estimate within 1 business day
• For services scheduled 10+ days out: providers must give estimate within 3 business days
• For walk-in services: estimate should be provided upon request

The $400 Rule:

• If the actual bill is at least $400 more than the Good Faith Estimate, you can dispute it
• This threshold applies to the total bill, not individual line items

Patient-Provider Dispute Resolution (PPDR) Process:

• You must initiate the dispute within 120 calendar days of receiving the bill
• There's a $25 fee to start the process (waived if you can't afford it)
• An independent reviewer will determine if the bill is substantially in excess of the estimate
• The decision is binding on the provider

Get It in Writing:

• The estimate must be in writing
• It should be specific to your situation and condition
• Keep the estimate — you'll need it if you dispute the final bill

For Scheduled Services:

• Request when you schedule your appointment
• Confirm all providers who will be involved
• Ask about potential additional services that might be needed

For Ongoing Treatment:

• Request estimates for each episode of care
• Get updated estimates if your treatment plan changes

Uninsured Patient Discounts:

• Many providers offer discounts for uninsured patients
• Ask about self-pay rates when getting your estimate
• Non-profit hospitals must have financial assistance policies

Payment Plans:

• Providers cannot require full payment upfront
• You have the right to request payment plans
• Get payment agreements in writing

Network Adequacy:

• If you're using insurance but going out-of-network by choice, you may still be entitled to an estimate
• Some state laws require estimates even for insured patients

Pro Tips:

• Always request estimates for any non-emergency care
• Compare estimates between providers — prices can vary dramatically
• Keep your Good Faith Estimate safe — you'll need it if costs exceed expectations
• Remember: an estimate isn't a contract, but significant overcharges can be disputed