Money Basics

Got a Big Medical Bill? Ask for the Good Faith Estimate

By Maren Hale / November 6, 2026

Woman with her hand to her forehead reviewing paperwork beside a laptop

Four numbers cover most of this topic: 3 business days, $400, 120 days and $25. If you have no health insurance, or choose not to use it for a service, federal rules under the No Surprises Act generally entitle you to a written good faith estimate before the care. If the bill later lands at least $400 above that estimate, and you act within 120 days, you can ask an independent reviewer to decide what is owed, for a $25 fee. It only works if you have the estimate, so the time to ask is before the appointment. This is how the government’s own pages describe it as of November 8, 2026.

Key takeaways

The rule covers people with no health insurance, or who are not using it for that service. If you are using insurance, a different process applies.
Providers generally must give an estimate if you schedule care at least 3 business days ahead, or if you ask for one. Emergency care does not come with one.
Each estimate covers one provider or facility, so a surgery can mean several estimates.
The dispute process opens when a provider or facility charged at least $400 more than its estimate and your initial bill is dated within the last 120 calendar days. The fee is $25.
No estimate, no federal dispute. Keep a copy of every one.

Who gets an estimate, and when

CMS (the Centers for Medicare & Medicaid Services) says the estimate is for people in the U.S. who do not have health insurance, or who have it but choose not to use it. Its examples: a service insurance would not cover, or a case where paying out of pocket costs less. The Consumer Financial Protection Bureau (CFPB) describes the same group.

Timing depends on when the care is scheduled. CMS gives this schedule:

Situation	What CMS says
Care scheduled 0 to 2 business days ahead	No entitlement to an estimate
Care scheduled 3 to 9 business days ahead	Estimate provided within 1 business day
Care scheduled 10 or more business days ahead	Estimate provided within 3 business days
You ask for one before scheduling	Provided within 3 business days of your request
Emergency care	No estimate during emergency care

Business days are Monday through Friday. The estimate must be an itemized list, delivered on paper or by email as you prefer, and the provider can also walk you through it by phone or in person if you ask.

How to ask

CMS suggests asking in writing. You do not need to say “good faith.” If a provider does not offer one, request it directly. Keep the estimate, and photograph it if you have a phone, so you can compare it with the final bill line by line.

What the estimate covers, and what it does not

An estimate lists expected charges for the scheduled items and services, including facility, hospital and room-and-board fees. It is not a bill. Two limits catch people out:

One provider or facility per estimate. For surgery you might get separate estimates from the surgeon and the hospital, and CMS suggests asking each provider and facility involved.
Foreseen care only. Separately scheduled services, such as pre-surgery appointments or later physical therapy, may be left out. So may services from other providers or facilities, and anything nobody anticipated.

When the bill comes in high: the dispute process

CMS calls this the patient-provider dispute resolution process. An independent third party reviews the bill and determines an appropriate payment. CMS lists these conditions, all of which must apply:

You did not have health insurance, or did not use it to pay for the care.
You told your provider before the care that you were not using insurance.
You received the care on or after January 1, 2022.
You received a good faith estimate three days before your scheduled appointment, as the page words it.
Your initial bill is dated within the last 120 calendar days.
A provider or facility charged at least $400 more than its good faith estimate.

One wording wrinkle: CFPB’s page says “more than $400” in one place and “at least $400” in another. CMS says at least $400 more, so treat CMS as the reference.

How it works

The dispute does not start until the $25 non-refundable fee is paid. If you win, the $25 is deducted from what you owe the provider. You can pay online or by mail with a money order or cashier’s check, but not with cash or a personal check. You start online, after requesting a one-time PIN, or by mail or fax with the billing dispute initiation form. Do not mail originals. You need your estimate, your provider’s contact information and your bill.

While the dispute is open, the provider or facility cannot send the bill to collections or threaten to, cannot collect existing late fees until it ends and cannot take action against you for disputing. If you and the provider agree on a payment before a decision, the provider must cut the bill by at least $12.50.

The outcomes CMS describes are plain. If the extra costs were unanticipated and appropriate, the bill stays. If the provider should have disclosed them in advance, or the services were not medically necessary, the provider has to reduce the bill. CMS gives no review timeline. If you win and are still billed or sent to collections, CMS says to complain to the No Surprises Help Desk, which CFPB lists at 1-800-985-3059, 8 a.m. to 8 p.m. Eastern, seven days a week.

Other levers on a big bill

CFPB’s advice on bills you cannot pay is a good second list. It suggests confirming you owe the charge, since people are sometimes billed twice or under a similar name, and asking for an itemized list of charges. It points to financial assistance programs, often called charity care. Under the Affordable Care Act, nonprofit hospitals with 501(c)(3) status must have them, and some states require more.

CFPB also says to ask about an interest-free payment plan and to try negotiating the balance. It cautions that paying with a credit card or medical credit card can bring high interest and weaken your hand in negotiating, and that unpaid bills can lead to late fees, collections, lawsuits, garnishment and lower credit scores. If you used insurance, CMS points to a complaint in certain cases or an appeal through your plan.

A checklist before, during and after care

Before scheduling: tell the provider you are not using insurance, and ask for the estimate in writing.
Count the days: scheduling at least 3 business days out is what triggers the requirement.
Ask each provider and facility for its own estimate.
Save the estimate and photograph it.
When the bill arrives, compare it line by line and ask for an itemized list of charges.
Note the date on the initial bill. The 120-day clock runs from it.
If the gap is $400 or more, gather the estimate, the bill and the provider’s contact details before starting.
Ask about financial assistance and payment plans at the same time.

Frequently asked questions

I used insurance. Can I use this process?

Not this one. CMS ties the dispute process to people who did not have insurance or did not use it. If you used insurance, it points to a complaint in certain cases or an appeal through your plan.

What if I never got an estimate?

Without one you cannot use the federal dispute process. CMS says that if you should have received one and did not, you can submit a complaint, though you remain responsible for paying the bill.

Does the estimate cap what I will pay?

The government pages describe it as an estimate of expected charges, not a bill. The dispute process is the recourse if the final bill is at least $400 over.

Is the $25 fee at risk?

It is non-refundable. If the dispute goes your way, it is deducted from what you owe. If you settle first, the provider must reduce the bill by at least $12.50.

Before you decide

If you are about to pay for care without insurance, the cheapest step costs nothing: ask for the estimate and keep it. For a bill already in hand, check the date, the gap over the estimate and whether you have the paper trail. CMS and CFPB update their pages, so confirm current details before paying the $25 or mailing anything. For a specific bill, the No Surprises Help Desk, a patient advocate or the hospital’s financial assistance office can look at your actual documents.