Short answer. A good faith estimate is a written estimate of expected charges that providers must give uninsured and self-pay patients. If the final bill exceeds the estimate by $400 or more for a listed provider, the patient may use the patient-provider dispute resolution process. This is a separate track from provider-payer IDR.
Who has to issue one
Any provider or facility scheduling an item or service for an uninsured or self-pay patient — or responding to a request from one — must furnish a written good faith estimate of expected charges. This applies whether or not the patient asks, once care is scheduled.
Timelines
- Service scheduled at least 3 business days out: estimate within 1 business day of scheduling.
- Service scheduled at least 10 business days out: estimate within 3 business days of scheduling.
- Patient requests an estimate without scheduling: within 3 business days of the request.
- If the scope changes, a revised estimate is required before the service.
What the estimate has to contain
- Patient name and date of birth
- A clear description of the primary item or service, and the date scheduled
- Itemized list of items and services reasonably expected to be furnished, including those from co-providers and co-facilities
- Applicable diagnosis codes, service codes and expected charges
- Provider and facility identifiers, including NPI and TIN, and the location of service
- A disclaimer that the estimate isn't a contract, that actual charges may differ, and that the patient may dispute a bill exceeding the estimate
The $400 line. If the final bill exceeds the good faith estimate by $400 or more for a given provider, the patient may use the patient-provider dispute resolution process. Initiation carries a small administrative fee and a selected dispute resolution entity decides the amount owed.
Where providers get tripped up
- Treating it as optional when the patient didn't ask — it isn't.
- Omitting co-provider items entirely, or issuing an estimate that covers only your own line.
- Missing the 1-business-day turn on short-notice scheduling.
- Confusing this with insured-patient rules — a good faith estimate for an uninsured patient is a different obligation from the balance billing and IDR rules that apply to insured claims.
How it relates to IDR
Good faith estimates concern uninsured and self-pay patients. Underpayment by a health plan on an insured out-of-network claim is a separate matter, resolved through independent dispute resolution. Different process, different clock, different money — groups conflate them constantly.