Good Faith Estimate
What is a Good Faith Estimate?
As a result of the federal No Surprises Act, as of Jan. 1, 2022, health care providers are required to give Good Faith Estimates to patients who are uninsured or have insurance but choose to self-pay. A Good Faith Estimate is a health provider’s best judgment of what services rendered or items provided will cost. It includes secondary items or services provided along with the primary care even if the patient will receive them from another provider or facility.
Am I eligible for a Good Faith Estimate?
Patients who do not have health insurance or have it but are not using it are eligible for a Good Faith Estimate. Note that individuals with Medicare or Medicaid are generally not eligible for a Good Faith Estimate.
Is this the amount I will end up paying?
A Good Faith Estimate is what a provider reasonably believes a patient will end up paying. Unforeseen costs may end up arising during the course of care. If a provider anticipates or is notified of changes that affect a Good Faith Estimate, such as new services to be rendered, the provider must give the patient a new Good Faith Estimate at least one business day before the appointment if possible.
What rights do I have as a patient?
If you are self-paying for health care or are uninsured, you have the right to receive a Good Faith Estimate. A Good Faith Estimate must be provided either electronically or in paper form. A patient can receive one verbally as well, but a more permanent copy (i.e. electronically or in printed form) of the Good Faith Estimate must still be given to the patient.
A Good Faith Estimate must include the patient’s name and date of birth, a description of services or items to be rendered, an itemized list of items or services reasonably expected to be provided, diagnostic codes, expected service codes, anticipated charges, name of the provider/facility, and location of the facility where the services or items are expected to be rendered.
If services are scheduled at least three business days beforehand, a Good Faith Estimate must be provided to the patient within one business day of the date of scheduling. For services or items scheduled at least 10 days beforehand, a Good Faith Estimate must be provided to the patient no later than three business days after the date of scheduling.
If changes occur to the scope of the Good Faith Estimate, such as in the services to be rendered or the location, the provider must offer a new Good Faith Estimate at least one business day before the services or items are to be provided by the facility.
If the actual price ends up exceeding the Good Faith Estimate, you may dispute it.
How do I dispute/appeal the cost?
You may appeal the final cost by contacting the health care provider and asking them to update the bill to match the Good Faith Estimate, asking to negotiate the bill, or asking if financial assistance is available. Appealing a bill does not impact the quality of care you receive.
You may also start a dispute resolution process with the U.S. Department of Health and Human Services if the actual price is at least $400 more than the estimated price. If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about four months) of the date on the original bill.
There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
If you dispute your bill, the provider or facility cannot move the bill for the disputed item or service into collection or threaten to do so. If the bill has already moved into collection, the provider or facility must halt collection efforts. The provider or facility must also suspend the accrual of any late fees on unpaid bill amounts until after the dispute resolution process has concluded and cannot take or threaten to take any retributive action against you for disputing your bill.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit https://www.cms.gov/nosurprises/consumers or call 1- 800-985-3059.