GOOD FAITH ESTIMATE
What is a good faith estimate, and what if my bill is higher?
A good faith estimate is a provider’s written estimate of what your care will cost if you don’t have or don’t use health insurance. CMS says you usually get one when you schedule care at least 3 business days ahead or ask for one — and you may be able to dispute the bill if it is at least $400 more than the estimate.
Why it’s confusing
Most people never see one, because the rule is for people who are uninsured or choose to pay themselves. Those are the people most exposed to a large bill.
An estimate from one provider may not include everything — a separate lab or anesthesia charge, for example — so the final bills can add up to more than the figure you were given.
How to read it
Check who it is from and what it covers: the services, the expected dates and the expected charges. Keep a copy.
When the bills arrive, compare each one with the estimate for that provider.
If a bill is at least $400 more than the estimate, CMS says you may be able to dispute it. Its help line (1-800-985-3059) can explain the process and take complaints.
What it does not mean
- That the estimate is a fixed price. It is an estimate, and bills can differ.
- That it applies when you use insurance. Insured people are covered by other No Surprises Act protections instead.
- That a bill $400 over is automatically cancelled. You may be able to dispute it through the process CMS describes.
Where you’ll see it
- Written estimates from providers when you book care as a self-pay patient.
- Price discussions before planned procedures.
Questions worth asking
Ask the provider
- Can I have a good faith estimate for this care?
- Does it include other providers involved, such as anesthesia or lab work?
- Why is my bill different from the estimate?
Bill higher than your estimate? Attach it, and Clariti will explain each charge so you know what to ask.
Common questions
- Who can get a good faith estimate?
- CMS says providers usually must give one if you don’t have or don’t use health insurance and you schedule care at least 3 business days ahead or ask for one.
- What is the $400 rule?
- CMS says you may be able to dispute your bill if it is at least $400 more than your good faith estimate.
- Where can I get help?
- CMS runs a No Surprises Act help line at 1-800-985-3059 for questions and complaints.