What is a Good Faith Estimate? Self-pay patient rights

Updated 2026-10-13 · Reviewed for accuracy by the EKO Labs team. Educational only; not medical advice.

If you pay for health care yourself, without insurance, a federal law called the No Surprises Act usually gives you the right to a written Good Faith Estimate of what your care will cost before you get it. This matters for cash-pay telehealthTelehealth a medical visit by video or phone. too. This guide explains who can get an estimate, what it must include, when you should receive it, and what you can do if your bill is much higher. It is general information, not legal, financial or medical advice.

Who can get a Good Faith Estimate

The rule (45 CFR 149.610) protects “uninsured (or self-pay)” individuals. That means you:

• have no health coverage for the item or service; or
• have job-based, individual or federal employee (FEHB) coverage but choose not to use it and tell the provider you will pay yourself.

If you are enrolled in a federal health care program such as Medicare or Medicaid for that service, these self-pay estimate rules generally do not apply; ask your program about costs instead. The provider must ask whether you have coverage and whether you plan to use it.

When you should get it

According to CMS, which runs the No Surprises Act help desk, the timing depends on when you schedule:

• Scheduled 3 to 9 business days ahead: within 1 business day after scheduling.
• Scheduled 10 or more business days ahead: within 3 business days after scheduling.
• You ask for an estimate (even before scheduling): within 3 business days of your request.
• Scheduled 0 to 2 business days ahead: you are not entitled to an estimate.

Providers must treat any question about the cost of care under consideration as a request for an estimate. They must tell self-pay patients that estimates are available, on their website, in the office and when scheduling, in clear language and in accessible formats and the languages their patients speak.

What it must include

The estimate must be written, on paper or electronically as you prefer (an electronic one must be possible to save and print). Under 45 CFR 149.610(c) it must include:

• your name and date of birth;
• a plain-language description of the main item or service and, if scheduled, the date;
• an itemized list of the items and services reasonably expected for that period of care, grouped by provider or facility, including those from other providers who work together on your care;
• diagnosis codes, service codes and the expected charge for each item;
• the name, National Provider Identifier (NPI) and Tax ID of each provider or facility, and the state and location where care will be given;
• a list of related services that must be scheduled separately (they get their own estimates);
• statements that it is only an estimate, that it is not a contract and does not oblige you to use those providers, and that you can dispute a bill that is much higher, with instructions.

The “expected charge” is the provider’s cash or self-pay rate, including any discounts for self-pay patients. For recurring care, one estimate can cover up to 12 months if it clearly states how often and how many times the service is expected. If something in the plan changes, the provider must send a new estimate at least 1 business day before the care.

What it may not cover

CMS notes that an estimate lists expected charges for a single provider or facility, so you may receive more than one. It may leave out services scheduled separately, care from another provider or facility, and things the doctor could not anticipate. When you use telehealth, ask whether the estimate covers only the visit or also lab tests and the medicine itself, since a pharmacy or laboratory may charge separately.

If your bill is $400 or more above the estimate

If a provider or facility bills you at least $400 more than the total expected charges on its estimate, you may be able to use the federal patient-provider dispute resolution process (45 CFR 149.620). According to CMS:

• you must have the Good Faith Estimate and the bill (copies, not originals);
• you must start within 120 calendar days of the date of the first bill with the higher charges;
• there is a $25 non-refundable fee; if the decision is in your favor, it is deducted from what you owe the provider;
• an independent reviewer decides the amount you pay. It may keep the bill if the extra care could not reasonably have been anticipated, or reduce it. CMS says your costs will not increase because you disputed.

While the dispute is pending, the provider or facility must not send the bill to collections or threaten to, must stop collection efforts already under way, must pause late fees, and must not retaliate against you for using the process.

If you never got an estimate

You can ask for one at any time, and you can ask for a copy of an earlier estimate: it is part of your medical record and must be kept for 6 years. Without an estimate you cannot use the dispute process, but if you think you should have received one, you can submit a complaint to CMS. The No Surprises Help Desk is 1-800-985-3059 (English, Spanish and many other languages). For problems with debt collectors or credit reports, CMS points to the Consumer Financial Protection Bureau (1-855-411-2372).

Questions to ask before your visit

• Can I have a written Good Faith Estimate for this visit as a self-pay patient?
• Which providers or facilities are included, and which will send their own estimate?
• Does the estimate include lab tests, follow-up visits or the medicine itself?
• Does the expected charge already include your self-pay discount?
• If my care is recurring, how many visits and months does this estimate cover?

Sources: 45 CFR 149.610 and 149.620 (eCFR, consulted October 2026); CMS, “What is a good faith estimate?”, “Dispute a medical bill” and “Medical bill rights” (cms.gov, consulted October 2026). This guide is general information, not legal, financial or medical advice. Rules and fees can change; check CMS before acting.