What is a good faith estimate?
What's included in a good faith estimate?
A good faith estimate should include expected charges for the scheduled health care items and services, including facilities fees, hospital fees, and room and board provided by the provider or facility.
Good faith estimates only list expected charges for a single provider or facility. You may get an estimate from both your provider and facility, or from multiple providers.
The estimate must:
- Include an itemized list with specific details and expected charges for items and services related to your care.
For example: you’re scheduled for surgery. You should request 2 good faith estimates: one from the surgeon, and one from the hospital.
The two estimates could include services like:
- The cost of the surgery
- Hospital fees
- Be given to you in the way you prefer, either printed on paper or emailed.
Note: A provider or facility can discuss the information included in the estimate over the phone or in person if you ask.
- Be in a format that’s accessible to you, including large print, braille, or audio.
A good faith estimate might not include:
- Items or services related to your care that are scheduled separately, like pre-surgery appointments, or physical therapy in the weeks after surgery.
- Items or services related to your care that will be provided by another provider or facility.
- Additional items or services that your doctor didn’t anticipate before providing care.
How soon can I get my good faith estimate?
You should get a good faith estimate if you schedule an appointment at least 3 business days in advance. You can ask your provider directly for an estimate if they don’t give one to you.
- When you schedule care 0-2 business days in advance, you aren't entitled to get a good faith estimate.
- When you schedule care 3-9 business days in advance, you'll get the estimate within 1 business day.
- When you schedule care 10 or more business days in advance, you'll get the estimate within 3 business days.
You can ask your provider for an estimate before you schedule care. They must give it to you within 3 business days.
What happens if I don't get a good faith estimate?
You’ll need a good faith estimate if you need to dispute your bill. You can’t dispute your bill without an estimate.
Ask your provider for an estimate if they haven’t given you one. If you lose your estimate, ask your provider for a new copy.
If you didn't get a good faith estimate, and you think you should have, submit a complaint.
In most cases, your provider is required to give you a good faith estimate before you get care. When you submit a complaint, you're still responsible for paying the bill. But it will ensure that you and other patients get a good faith estimate in the future.