What is a Good Faith Estimate?
A Good Faith Estimate (GFE) is a written estimate of what care is expected to cost. Under the federal No Surprises Act, health care providers must give one to patients who are uninsured or are not using their insurance.
Who gets a Good Faith Estimate
The rule covers uninsured and self-pay individuals. Self-pay includes people who do have insurance but don't seek to have a claim for the service submitted to their plan. If you schedule care at least three business days ahead, or simply ask for an estimate, you are entitled to one.
The requirement applies to many kinds of providers, including therapists, counselors and other mental health professionals, not just hospitals and doctors.
When you get it
| Situation | Deadline for the estimate |
|---|---|
| Scheduled 3 to 9 business days ahead | Within 1 business day of scheduling |
| Scheduled 10 or more business days ahead | Within 3 business days of scheduling |
| You ask for an estimate | Within 3 business days of the request |
What it includes
- Your name and date of birth.
- The main service and, if scheduled, its date.
- An itemized list of expected services with service codes and expected charges, plus diagnosis codes where applicable.
- The provider's name, NPI, tax ID and where the care will happen.
- Disclaimers: it is only an estimate, it is not a contract, and you can dispute the bill if it is much higher.
For ongoing care such as weekly therapy, one estimate can cover up to 12 months if it states the expected frequency and number of sessions. See an example.
If the bill is higher than the estimate
If a provider bills you at least $400 more than their estimate, you can start the federal patient-provider dispute resolution process. You have 120 calendar days from the date of the bill and pay a $25 fee. Details are at cms.gov/nosurprises or 1-800-985-3059.
Are you a provider? Create a compliant Good Faith Estimate with the required disclaimers in a few minutes. Free, and client details stay in your browser.
Create a Good Faith EstimateProviders: the full rules, including record keeping and what is not yet enforced, are in our guide to Good Faith Estimate requirements.
Questions
Do I get a Good Faith Estimate if I use insurance?
Not under the current rules. Estimates for insured patients (sent through the health plan as an Advanced Explanation of Benefits) are still waiting on federal rulemaking. More on insured patients.
Is a Good Faith Estimate the same as a mortgage Good Faith Estimate?
No. Mortgage lenders used a different form with the same name, which was replaced by the Loan Estimate in 2015. This page is about health care.
Is a Good Faith Estimate a contract?
No. It does not oblige you to receive the services or use that provider.