Good faith estimates and the $400 dispute rule

If you don't have insurance, or you choose not to use it, you have a right to a price before scheduled care. That price comes as a good faith estimate (GFE). If your bill lands far above it, a federal good faith estimate dispute process may bring it down.

This page is part of our guide on how to avoid surprise medical bills. Here's how estimates and the $400 rule work.

Who gets a good faith estimate?

Since January 1, 2022, the No Surprises Act has required providers and facilities to give estimates to people who are uninsured or self-pay. That includes:

• People with no health coverage
• People whose coverage doesn't include the service they're getting
• People who have coverage but don't want a claim sent to their plan

If you'll pay yourself, say so when you schedule. Providers must tell you that estimates are available, both in writing and when you ask about costs.

You won't get an estimate during emergency care.

When should your estimate arrive?

You get an estimate when you schedule care at least 3 business days ahead, or any time you ask. The deadline depends on the timing.

The estimate must be in writing, on paper or electronically, whichever you prefer. A provider can talk you through it by phone, but it still has to send a written copy. If your plans change, the provider must send a new estimate at least 1 business day before your care.

Keep every estimate, and take a picture of it. If you lose it, providers must give you a copy of any estimate from the last 6 years.

What must the estimate include?

A good faith estimate must list:

• Your name and date of birth
• A plain description of the main service, and its date if it's scheduled
• Each item and service you're expected to get, grouped by provider or facility
• Diagnosis codes, service codes, and the expected charge for each item
• The name, National Provider Identifier, and tax ID number of each provider, plus where you'll get care
• Related care that needs its own scheduling, like tests before surgery or therapy after
• Notes saying it's only an estimate, it isn't a contract, and you can dispute a bill that's far above it

Why a bill can come in above the estimate

Common reasons for a gap include:

• Your care changed, like an extra test or a longer stay.
• A provider took part who wasn't on any estimate, such as a lab or an anesthesiologist.
• An item was billed at a higher price than the estimate listed.
• A billing mistake, such as the same charge listed twice.

How does the $400 dispute rule work?

The federal patient-provider dispute resolution process is open to you if all of these are true:

• You didn't have or didn't use insurance for the care, and you told the provider ahead of time.
• You got a written good faith estimate before your care.
• The care happened on or after January 1, 2022.
• A provider's total bill is at least $400 more than the total on its estimate.
• You start within 120 calendar days, about 4 months, of getting the first bill.

The $400 test applies to each provider or facility separately. You can't add 2 providers' gaps together.

Starting a dispute costs $25, and the fee isn't refundable. If the decision goes your way, the $25 comes off what you owe the provider. If you and the provider settle first, the provider must lower your bill by at least $12.50.

What happens during the dispute

While the dispute is open, the provider can't send the disputed bill to collections or threaten to. If it's already in collections, the provider should stop collection efforts. Late fees on the unpaid amount are paused, too.

An independent reviewer chosen by the federal government looks at your estimate, bill, and the provider's records. It must decide within 30 business days of getting the provider's information. It looks at each item on its own:

• If an item was billed at or below its estimate, you owe the billed amount.
• If an item was billed above its estimate, you owe the estimate amount. The exception is if the provider shows the extra cost was medically necessary and couldn't have been foreseen.
• If the provider does show that, the reviewer can allow more. The amount is capped by what health plans usually pay for that service in your area.
• An item that wasn't on the estimate at all is set at $0, unless the provider shows it was necessary and unforeseen.

You and the provider can still settle before the decision, for example with a lower price or financial assistance.

What to do

1. When you schedule, say you'll pay yourself and ask each provider for a written estimate.
2. Read each estimate before your care, and ask about anything that seems to be missing.
3. When a bill arrives, ask for an itemized bill. Our itemized bill request letter gives you the words.
4. Compare each provider's bill total with its estimate total.
5. Call the billing office. Ask them to fix the bill or explain the gap, and to hold the account while they check.
6. If a gap of $400 or more isn't fixed, start a dispute before 120 days pass. You can apply online or by mail, with copies of the estimate, the bill, and the $25 fee.

Say Andre doesn't have insurance. He schedules a knee procedure at a surgery center 2 weeks ahead. He tells both the center and the surgeon that he'll pay himself, and each one sends him an estimate.

Provider	Estimate	Bill	Gap	$400 or more?
Surgery center	$3,200	$3,750	$550	Yes
Surgeon	$1,500	$1,800	$300	No
Total	$4,700	$5,550	$850

The combined gap is $850, but the rule looks at each provider alone. Only the surgery center's bill qualifies.

Andre's itemized bill shows a $550 supply charge that wasn't on the center's estimate. Every other line matches the estimate. The billing office says the bill is correct. So 40 days after the first bill, Andre starts a dispute and pays the $25 fee. While it's open, the center can't send his bill to collections.

Here's 1 way it could end. The reviewer finds that the center didn't show the supply was needed for a reason it couldn't foresee. It sets that item at $0, which brings the bill to $3,200. Then it takes off the $25 fee, so Andre owes $3,175. With the fee he already paid, his total is $3,175 + $25 = $3,200, the amount on his estimate.

For the surgeon's $300 gap, Andre can still ask the billing office to explain it or offer a self-pay discount.

What if you have insurance?

The No Surprises Act also calls for estimates for people who use insurance. Your provider would send an estimate to your plan. Your plan would then send you an advanced explanation of benefits with your expected share.

As of September 2026, these rules aren't in effect. Federal agencies won't enforce them until they finish writing the regulations. In the meantime, use your insurer's online cost estimator or call member services.

You can also choose not to use your insurance for a service and ask for a good faith estimate. Before you do, ask your plan how paying yourself would affect your deductible.

To compare prices first, see our hospital price transparency lookup guide. If you're picking coverage for next year, see how to choose a health insurance plan.

When to get help

A call or 2 to the billing office often settles a gap. It's worth getting help when:

• A provider won't give you an estimate, or won't explain a large gap.
• You're close to the 120-day deadline and aren't sure how to start.
• The bill is already in collections.
• The bill is correct, but you can't afford it.

The No Surprises Help Desk answers questions at 1-800-985-3059. It can explain your next steps and help you submit a complaint. State rules may add more protections, and your state's consumer assistance program can explain them.

If the bill is from a hospital, ask about hospital charity care and self-pay discounts. A medical bill advocate can make the calls for you. If a provider sues you, talk with an attorney.

If you can't pay what you owe, see what to do if you can't afford medical bills.