What Is a Good Faith Estimate?
A Good Faith Estimate (GFE) is a written notice that shows you the expected cost of your healthcare services before you receive care.
Under federal law, providers must give you this estimate if you're:
Uninsured, or
Choosing to pay cash (not using insurance or networks)
This is part of the No Surprises Act, which helps patients understand and prepare for medical costs ahead of time.
What Does the Estimate Include?
Your Good Faith Estimate will outline:
The type of care you're receiving
An itemized list of services and charges
The total expected cost
Any related services (like labs or imaging)
A disclaimer about your rights to dispute charges
Think of it as a price preview for your care with no surprise bills. You may need multiple different Good Faith Estimates from a few different providers if having a surgery (eg: Facility fees, provider fees, anesthesia, etc)
When Should You Receive It?
You should receive your Good Faith Estimate (GFE) in writing, and timing depends on when your care is scheduled or requested:
If you schedule care 10 or more days in advance, the provider must give you a GFE within 3 business days.
If you schedule care 3–9 days in advance, the GFE must be provided within 1 business day.
If you request an estimate without scheduling an appointment, the provider must supply a GFE within 3 business days.
You may request a Good Faith Estimate at any time, even if you have not yet committed to treatment.
Your Rights Under the No Surprises Act
You have the right to receive a Good Faith Estimate before any scheduled service.
If your final bill is $400 or more over the GFE, you can dispute the charges through a formal process through a CMS Patient-Provider Dispute.
You have 120 days from the date on your bill to file a dispute.
How We Support You as a Cash-Pay TPA
Help confirm cost is appropriate according to RBP and/or geographical data using tools like healthcarebluebook and fairhealthconsumer.org
Ensure providers follow GFE legal requirements
Assist in comparing estimates if you're choosing between providers
Support you if you need to dispute an unexpected charge
We believe that paying cash for care should be simple, predictable, and fair and the GFE is a key part of that.
Tips:
Always ask for a Good Faith Estimate specially, by name.
Keep your estimate in case you need to compare it to the final bill.
Don’t hesitate to ask questions - it's your right to understand the cost of your care.
Ask the main rendering provider (otherwise known as the Convening Facility according to the No Surprises Act) for Good Faith Estimates from all other anticipated services. This would include Anesthesia, Facility Charges, Provider Charges, Radiology, etc.
Example: If you are looking to gather GFE’s for an upcoming surgical procedure to have your tonsils removed, you would want to get a GFE from the facility where you will have surgery, the provider(s) preforming the surgery, and you would also need to inquire with the facility for an anesthesiologist GFE. It might take asking the facility specifically about all of these things to remind them these are charges that need to be considered and quoted out.
Why is a Good Faith Estimate so Important?
A Good Faith Estimate is extremely important because without it, patients have no protection against balance billing. When a valid Good Faith Estimate is provided, and the patient later receives a bill that exceeds the estimate by $400 or more, they have the right to initiate a Patient-Provider Dispute.
In this process, a neutral party - known as an Independent Dispute Resolution Entity (IDRE) - is assigned to review documentation from both parties, including bills and supporting statements. The responsibility then falls on the medical provider to demonstrate to the IDRE that any additional charges were medically necessary.
Helpful Links
General No Surprises Act information - https://www.cms.gov/medical-bill-rights
How to Submit a Complaint - https://www.cms.gov/medical-bill-rights/help/submit-a-complaint
Call CMS No Surprises Help Line: 1-800-985-3059
Visit: www.cms.gov/nosurprises