Good Faith Estimate, explained

The short version

Under the federal No Surprises Act (effective January 1, 2022), if you are uninsured or paying out of pocket without filing a claim, healthcare providers and facilities must give you a written Good Faith Estimate (GFE) of the expected charges for scheduled care. If the final bill is more than $400 above the estimate, you can file a federal dispute through HHS for a $25 fee.

When you should get a GFE

• When you schedule care that is at least 3 business days out — the provider must give it to you at least 1 business day before the service.
• When you schedule care 10+ business days out — at least 3 business days before.
• When you request one — within 3 business days, regardless of scheduling.

Providers are required by federal law to inform you of your right to a GFE. In practice, many don't — so ask in writing if you don't see one.

What must be on a GFE

• Your name, date of birth, and a description of the service
• An itemised list of expected services and items, with diagnosis and service codes (CPT/HCPCS)
• The expected charge for each item
• The provider's name, NPI, and TIN
• Any items or services the convening provider knows will be furnished by other providers (co-providers)
• A disclaimer explaining your right to dispute

The $400 dispute right

If your final billed charges exceed the GFE total by more than $400 for any individual provider, you may use the federal Patient-Provider Dispute Resolution (PPDR) process:

1. File within 120 calendar days of the original bill.
2. Pay a $25 administrative fee (refunded if you win).
3. HHS assigns a certified independent dispute resolution entity (IDRE).
4. The IDRE reviews documentation; collection of the disputed amount is paused while the dispute is pending.
5. The IDRE's decision is binding on the provider.

Common GFE problems

• You weren't offered one. Ask in writing. Document the date you asked. If they refuse, file a complaint at cms.gov/nosurprises.
• Your GFE was missing co-provider charges. Anesthesia, lab, radiology, and assistant-surgeon costs frequently come in separately. The convening provider is supposed to disclose what they know about co-providers.
• Your final bill is much higher. Don't pay the disputed amount. File a PPDR within 120 days.

If you have insurance

GFE rules apply to uninsured and self-pay patients only. If you have insurance and chose not to file a claim, you may still qualify. If you're using insurance, the parallel protection is the Advanced Explanation of Benefits (AEOB), which the No Surprises Act also requires — but enforcement of the AEOB rule has been delayed pending further rulemaking. Practical advice: ask your insurer for a pre-treatment estimate of out-of-pocket cost before scheduling.

This is decision-support content, not legal advice. For large bills or complex cases, consult a healthcare-billing attorney or your state's Consumer Assistance Program.