Good Faith Estimates and the $400 Dispute Process

Providers and facilities must give a written Good Faith Estimate (GFE) to patients who are uninsured, or who are insured but choose not to submit the claim to their plan (self-pay).^[1] You can also request one before scheduling anything, simply to shop on price.

If you're using insurance, this isn't your document — ask your plan for an Advanced Explanation of Benefits or a pre-service cost estimate instead.

• Scheduled at least 10 business days out → estimate within 3 business days.
• Scheduled 3–9 business days out → estimate within 1 business day.
• Scheduled fewer than 3 business days out → no estimate required.
• On request (not scheduling) → within 3 business days.

Providers must also notify you of your right to one, in writing and orally, and post it publicly.^[1]

• Your name and date of birth.
• A plain-language description of the primary service and the scheduled date.
• An itemized list of items and services expected, with codes and expected charges.
• Items and services expected from co-providers — the surgeon, the anesthesiologist, the facility, the pathologist — coordinated by the convening provider.
• The provider's name, NPI and TIN, and the location of service.
• A disclaimer that it is an estimate and that you have dispute rights.

Keep the PDF or paper copy — you cannot dispute without it.

If the final billed charge from a provider is at least $400 more than that provider's estimate, you may initiate the federal Patient-Provider Dispute Resolution (PPDR) process.^[2] The comparison is per provider, not against the sum of all estimates, so a $300 overage from the facility and a $500 overage from the anesthesiologist means only the second is disputable.

1. Act within 120 calendar days of receiving the bill — this deadline is strict.
2. Gather the GFE, the itemized bill, and any communications about scope changes.
3. File through the CMS dispute portal, or by mail/fax using the CMS form; the No Surprises Help Desk (1-800-985-3059) can walk you through it.^[2]
4. Pay the administrative fee — a nominal amount, waived or reduced for low-income patients.
5. Keep proof of submission and note the dispute number.

A certified independent dispute resolution entity reviews the estimate and the bill and decides what you owe. It may set the amount at the estimate, or at the billed amount if the provider shows the extra services were medically necessary and could not reasonably have been anticipated.^[2],[3] While the dispute is open, the provider must not move the bill to collections, must pause any existing collection activity, and must not charge late fees.

• Ask for the estimate in writing every time, even for routine outpatient care.
• Check that co-provider charges are included; missing ones are the usual source of overage.
• If the plan of care changes mid-course, ask for an updated estimate before proceeding.
• Compare the estimate to a benchmark such as Medicare's rate for the same codes before agreeing.
• Apply for hospital financial assistance in parallel — the two processes don't conflict.