If the Bill Is $400 Over Your Good Faith Estimate, You Can Dispute It

Key takeaways

• Get a Good Faith Estimate in writing before care, from every provider involved — the hospital, the surgeon, the anesthesiologist, each one separately.
• If one provider's bill comes in $400 or more above its estimate, federal law gives you a way to dispute it.
• Start the dispute within 120 days of the bill date. It costs $25.
• Under $400, or with no estimate at all, the federal process does not open — but you can still check the bill, negotiate, and ask about financial assistance.

If you pay for care yourself, without using insurance, the provider has to tell you in writing what it will cost before you get it. That written number is called a Good Faith Estimate. And if the bill from that provider comes in at least $400 higher than the estimate, federal law gives you a way to dispute it.

This is not a discount program. It is a check on a quote you were given in writing. It only works if you get the estimate first, so the most important step happens before your appointment, not after the bill arrives.

Who gets a Good Faith Estimate?

You qualify if you do not have health insurance, or if you have it but choose not to use it for this service. For example, you might pay cash for a scan because the cash price beats what your plan would charge (see Should You Use Your Insurance — or Pay Cash?).

If you run the visit through your insurance, this process is not your route. Then you compare the bill to your plan's Explanation of Benefits instead, and you use your plan's appeal process if something is wrong (see How to Read Your Itemized Hospital Bill).

What the estimate must include

Ask for it when you schedule care, or any time before the visit. Providers must give one when you schedule care at least three business days ahead, or when you ask for one. Get it in writing, on paper or by email, and keep your copy.

A proper estimate lists the items and services the provider reasonably expects to deliver, with the service codes and the expected charge for each one. It should also explain what to do if the bill comes in higher.

One catch: each provider or facility gives its own estimate. The hospital, the surgeon, and the anesthesiologist can each bill separately, and each one has its own estimate. The $400 rule is measured per provider or facility, not across your whole bill added together. So ask every provider involved: "Will you send me a Good Faith Estimate for your part?"

Before you agree to anything, it also helps to check the going rate: look up the procedure on Patients Price to see what hospitals report charging for it.

If the bill comes in higher

First, compare the bill to the estimate line by line. Look for charges for items that were never in the estimate, duplicate lines, or services you did not receive. Then call the provider's billing office. Some overcharges are plain errors, and some can be fixed with a phone call. While you are there, ask about financial assistance too. If you qualify, it can reduce or erase the bill before you dispute anything (see You Might Not Have to Pay That Hospital Bill).

If the gap is still at least $400 for one provider, you can start the federal patient-provider dispute resolution process. Work it out provider by provider: say your surgeon estimated $2,000 and billed $2,500 — that is $500 over, so the dispute process opens. If the bill had been $2,300 instead — $300 over — it would not open, even if your total bill across all providers is much higher. The rules:

1. Start within 120 calendar days of the date on the original bill. The clock runs from the bill date, not the day you opened the envelope, so do not wait.
2. It costs $25. You pay an administrative fee to start the dispute. The fee is deducted from what you owe if you win.
3. File through CMS. Start at the federal dispute portal (nsa-idr.cms.gov/billdisputes) or call the No Surprises Help Desk at 1-800-985-3059 for help. You will need your copy of the estimate, the bill, and the provider's contact details.
4. Collections pause while it is pending. The provider must not send the disputed amount to collections while the dispute is open, and must pause late fees on it.

An independent reviewer compares the bill with the estimate and with whatever the provider says in its defense. If the extra charges were not justified, the reviewer can lower what you owe, down to the estimate amount.

Three honest caveats

• An estimate is not a fixed price. Care can change during a procedure. If something medically necessary and unforeseen happened, the provider can argue the higher charge was justified, and the reviewer may agree. A dispute is not an automatic win.
• Under $400, there is no federal dispute. You can still call billing, ask for an itemized bill, dispute errors in writing, and negotiate. The $400 line only decides whether the federal process opens.
• No estimate, no dispute. If you never received one, you cannot use this process for that bill. You can still complain to CMS that the provider failed to give you one, and you can still negotiate and apply for financial assistance.

The bottom line

1. Paying yourself? Get a Good Faith Estimate in writing before care, from every provider involved.
2. Keep the estimate next to the bill and compare them line by line.
3. If one provider's bill is $400 or more above its estimate, start the federal dispute within 120 days of the bill date. It costs $25.
4. Under $400, or with no estimate at all, your tools are still the same ones in our other guides: check the bill, negotiate, and ask about financial assistance.

Sources: U.S. Centers for Medicare & Medicaid Services, Medical bill rights and the patient-provider dispute resolution portal; No Surprises Act rules at 45 CFR 149.610 and 149.620. This is general information, not legal advice. For a dispute, contact CMS or your state's insurance department.