Good faith estimates: what providers actually have to send

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

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.