Good Faith Estimate information

What is a Good Faith Estimate?

If you don’t have health insurance or you plan to pay for health care bills yourself, generally, health care providers and facilities must give you an estimate of expected charges when you schedule an appointment for a health care item or service, or if you ask for an estimate. This is called a “good faith estimate.”

A good faith estimate isn’t a bill. It shows the list of expected charges for items or services from your provider or facility. Because the estimate is based on information known at the time it is created, it won’t include any unknown or unexpected costs that may be added during your treatment.

What the estimate includes

Generally, the good faith estimate must include expected charges for:

• The primary item or service
• Any other items or services you’re reasonably expected to get as part of the primary item or service for that period of care

The estimate might not include every item or service you get from another provider or facility, even if some items or services may seem connected to the same service. You’ll get a separate good faith estimate when you schedule those items or services with the provider or facility, or if you ask for it.

Your right to a Good Faith Estimate

Providers and facilities must give you the good faith estimate:

• After you schedule a health care item or service. If you schedule at least 3 business days before the date of service, the provider must give you a good faith estimate no later than 1 business day after scheduling. If you schedule or ask for cost information at least 10 business days before the date of service, the provider must give you a good faith estimate no later than 3 business days after you schedule or ask.
• With a list of each item or service and specific details, like the health care service code.
• In a way that’s accessible to you, like in large print, Braille, audio files, or other forms of communication.

Providers and facilities must also explain the good faith estimate to you over the phone or in person if you ask, then follow up with a written (paper or electronic) estimate, per your preferred form of communication.

Keep your estimate

Keep the estimate in a safe place so you can compare it to any bills you get later. After you get a bill for the items or services, if the billed amount is $400 or more above the good faith estimate, you may be eligible to dispute the bill.

For more information, visit cms.gov/nosurprises or read the CMS Good Faith Estimate fact sheet.

Professional membership

Christine Stryjewski is a member of the National Association of Social Workers (NASW), national and Illinois chapters. NASW is the largest membership organization of professional social workers and works to enhance the growth and development of members, to create and maintain professional standards for all social workers, and to advance sound social policies. Learn more at socialworkers.org.