Good Faith Estimates: Free Price Transparency for Uninsured and Self-Pay Patients

Under the No Surprises Act, healthcare providers and facilities must give uninsured and self-pay patients a Good Faith Estimate (GFE) of expected charges before providing scheduled services. This estimate must include all items and services reasonably expected to be provided, including services from other providers (such as labs, anesthesiologists, or imaging centers) that the scheduling provider can reasonably anticipate. The GFE must be provided within specific timeframes: within 1 business day if the service is scheduled at least 3 days in advance, or within 3 business days if scheduled at least 10 days in advance. You can also request a GFE at any time.

Your GFE is more than an informational document — it is a powerful consumer protection tool: 1. Compare prices: Get GFEs from multiple providers for the same service. Prices for identical procedures can vary by 300-500% between providers in the same area. 2. Budget accurately: Use the estimate to plan your healthcare spending and evaluate whether you can afford the service or need to explore alternatives. 3. Dispute excess charges: If your final bill exceeds your GFE by $400 or more, you have the right to dispute the bill through the federal patient-provider dispute resolution (PPDR) process. 4. Negotiate upfront: Use the GFE as a starting point for negotiation. Many providers offer cash-pay discounts of 20-40% if you ask.

If your final bill is $400 or more above your Good Faith Estimate, you can initiate a dispute through the federal PPDR process within 120 calendar days of receiving the bill. The dispute process works as follows: - You submit a dispute through the CMS website or by mail - A Selected Dispute Resolution (SDR) entity reviews the case - Both you and the provider submit payment offers - The SDR entity selects the offer closest to the qualifying payment amount - The decision is binding on the provider Importantly, during the dispute process, you cannot be sent to collections for the disputed amount, and the provider cannot threaten adverse action against you for filing a dispute.

- Always ask for a GFE in writing, even if the provider does not offer one proactively - Request that the GFE include facility fees, which are often the largest component of a hospital bill - Ask whether the estimate includes all providers who will be involved in your care - Check the provider's machine-readable pricing file (required by federal law since 2021) for comparison - Use CMS's Hospital Price Transparency tool to compare prices across facilities - Keep your GFE — you will need it if your final bill exceeds the estimate The Good Faith Estimate requirement represents one of the most significant advances in healthcare price transparency in decades. Using it effectively can save you hundreds or thousands of dollars.