What Is a Good Faith Estimate and When Should You Ask for One?
Knowing what healthcare is expected to cost before you receive it can make it easier to plan, compare options, and avoid unexpected financial surprises.
For people who don't have health insurance—or who choose not to use their insurance for a particular service—federal law provides an important protection called a Good Faith Estimate.
A Good Faith Estimate gives you an advance list of the expected charges for scheduled healthcare services. It isn't a bill, and it doesn't necessarily represent the final amount you will pay. Instead, it gives you a written estimate that you can use to understand the expected cost of care before receiving it.
The requirement is part of the federal No Surprises Act, which took effect January 1, 2022.
But who qualifies for a Good Faith Estimate? When should you request one? What should it include? And what can you do if the final bill is significantly higher?
Let's take a closer look.
What Is a Good Faith Estimate?
A Good Faith Estimate (GFE) is a written estimate of the expected charges for healthcare items and services you are scheduled to receive.
It generally applies to people who:
- Don't have health insurance, or
- Have insurance but choose not to use it to pay for the particular care.
The estimate should provide an itemized list of expected healthcare services and their anticipated charges.
For example, if you're paying out of pocket for a scheduled procedure, the estimate could include the expected charge for the procedure and applicable facility fees.
A Good Faith Estimate is not the same thing as a medical bill.
It is designed to help you understand expected charges before you receive care.
Who Can Ask for a Good Faith Estimate?
Good Faith Estimate protections are primarily designed for uninsured and self-pay patients.
You may be considered self-pay if you have health insurance but decide not to submit the claim to your insurance plan for the service. This could happen because a service isn't covered or because you have determined that paying directly may be more appropriate for your situation.
If you're using your health insurance to pay for care, the Good Faith Estimate rules discussed here generally don't apply in the same way.
Instead, you should contact your health plan to understand your expected out-of-pocket costs and ask your provider for information about the expected charges.
When Should You Ask for a Good Faith Estimate?
You can ask for a Good Faith Estimate before scheduling your care.
CMS explains that providers generally must provide an estimate when an uninsured or self-pay patient requests one, even before the service has been scheduled. The estimate should generally be provided within three business days of the request.
You can also receive an estimate when you schedule care at least three business days in advance.
For example, if you schedule a procedure several weeks ahead, you should generally receive an estimate within the applicable timeframe.
The timing depends on how far in advance your appointment is scheduled:
10 or more business days before care: The estimate should generally be provided within three business days after scheduling.
3–9 business days before care: The estimate should generally be provided within one business day.
bEstimate under these scheduling rules.
Emergency care is also different. You generally won't receive a Good Faith Estimate for emergency services because emergencies cannot always be planned in advance.
What Should a Good Faith Estimate Include?
A Good Faith Estimate should provide an itemized list of expected charges for the healthcare items and services related to your scheduled care.
Depending on the situation, it can include expected charges such as:
- Procedures
- Diagnostic services
- Facility fees
- Hospital fees
- Room and board
- Other healthcare services associated with the scheduled care
The estimate should provide enough information for you to understand what you're expected to pay for the planned service.
You should receive the estimate in your preferred format, such as a paper copy or electronic version.
Does One Good Faith Estimate Cover Every Provider?
Not necessarily.
This is one of the most important things to understand.
A Good Faith Estimate generally lists expected charges from a single provider or facility.
If several providers are involved in your care, you may need to request estimates from each one.
For example, imagine you're planning surgery.
You may receive services from:
- The surgeon
- The hospital
- An anesthesiologist
- A laboratory
Because these providers may bill separately, one estimate may not represent the entire cost of your care.
CMS specifically gives the example that a patient scheduled for surgery may need one Good Faith Estimate from the surgeon and another from the hospital.
This is why it's important to ask:
“Will any other providers or facilities bill me separately?”
What a Good Faith Estimate May Not Include
A Good Faith Estimate isn't a guarantee that nothing unexpected can happen during or after treatment.
CMS explains that an estimate may not include services that are scheduled separately, services provided by another provider or facility, or additional services that weren't anticipated before care was provided.
For example, a procedure may be estimated at one amount, but additional care could become necessary based on circumstances that weren't known beforehand.
This doesn't mean the estimate is useless.
It means you should understand what the estimate covers and what it doesn't.
Before signing up for care, ask the provider to explain any services that aren't included.
Can You Negotiate the Cost Before Receiving Care?
A Good Faith Estimate can also be a useful starting point for discussing healthcare costs with your provider.
If the estimated cost is higher than you expected, ask whether the provider offers:
- Payment plans
- Financial assistance
- Self-pay discounts
- Alternative payment arrangements
CMS recommends asking providers about payment options and financial assistance when medical costs are difficult to afford.
The earlier you have this conversation, the more options you may have to plan for the expense.
How Long Do You Have to Dispute the Bill?
CMS currently states that eligible patients generally have 120 calendar days from the date of the initial bill to begin the dispute process.
That's roughly four months.
The important lesson is simple:
Keep your estimate and review your bill as soon as you receive it.
Conclusion
A Good Faith Estimate gives uninsured and self-pay patients an important opportunity to understand expected healthcare costs before receiving planned care.
Under federal rules, providers generally must provide an estimate when an eligible patient requests one or schedules care at least three business days in advance.
The estimate should provide an itemized list of expected charges, but remember that it may not include services from other providers or unexpected services that weren't anticipated when the estimate was prepared.
That's why it's important to ask whether other providers will bill you separately.
Most importantly, save your Good Faith Estimate.
If an eligible provider later bills you at least $400 more than the estimate, you may be able to use the federal patient-provider dispute resolution process.
Healthcare costs can be complicated, but asking for information before receiving care can put you in a much stronger position.
The more you understand before your appointment, the fewer financial surprises you may face afterward.
Know Your Healthcare Costs Before You Receive Care
A Good Faith Estimate can be a valuable tool for people paying for healthcare without using insurance. Knowing what to request, what the estimate includes, and what to do if the final bill is significantly higher can help prepare
If you have questions about your health insurance coverage or want help understanding your healthcare costs, schedule a consultation through the Belle Vida Insurance consultation scheduler.