What is a Good Faith Estimate?
A Good Faith Estimate is a written or electronic list of expected charges for healthcare items and services. Under federal protections described by the Centers for Medicare & Medicaid Services (CMS), people who do not have health insurance or who choose not to use it can usually receive an estimate when they request one or schedule qualifying care in advance.
The estimate is designed to improve cost transparency. It is not a guarantee that the final bill will be identical, and it does not replace a clinical evaluation. Unexpected needs, separately scheduled care, and services from another provider or facility may affect the total cost.
Who should request an estimate?
Ask for an estimate if you do not have health insurance or if you have coverage but will not use it for the planned service. Tell the office clearly that you are paying without insurance so it can identify which federal estimate rules may apply.
Emergency care is different. CMS states that patients do not receive a Good Faith Estimate during an emergency. Do not delay emergency evaluation because of cost questions; call 911 for immediate danger.
When should the estimate arrive?
CMS gives the following general timing rules for scheduled care:
- If care is scheduled 3 to 9 business days in advance, the estimate is generally due within 1 business day.
- If care is scheduled 10 or more business days in advance, the estimate is generally due within 3 business days.
- If you ask for an estimate before scheduling, it is generally due within 3 business days.
If you schedule only 0 to 2 business days ahead, the federal advance-estimate timing protection generally does not apply. You can still ask the office for available price information.
What should a Good Faith Estimate contain?
CMS says an estimate should include an itemized list of expected charges for the scheduled items and services. It should be available on paper or electronically, based on your preference, and in an accessible format when needed.
Read the provider and facility names carefully. CMS notes that an estimate may list expected charges for only one provider or facility. A clinician, laboratory, imaging center, hospital, pharmacy, or other organization may have its own charges. Ask each one whether it will send a separate estimate or bill.
Five questions to ask before a self-pay visit
- What appointment or service is included? Confirm the visit type, length, setting, and scheduled items.
- Could any organization bill me separately? Ask about laboratories, imaging, prescriptions, procedures, facilities, and referrals.
- Is follow-up included? Confirm whether result review, messages, refill requests, forms, or another appointment may have separate charges.
- Could the plan change after evaluation? An exam or new information may show that testing, in-person care, referral, or urgent treatment is needed.
- How will I receive and keep the estimate? Request a dated written or electronic copy and save it with receipts and bills.
How to compare the estimate with the final bill
Match the provider or facility name, service description, service date, and each charge. Ask for an itemized bill if you do not have one. If a line is unfamiliar, duplicated, or different from the planned service, contact the billing office and ask for an explanation or correction.
CMS says you may be eligible for the federal patient-provider dispute process if a bill from a provider or facility is at least $400 more than the Good Faith Estimate from that same provider or facility. Eligibility and deadlines matter, so use the current CMS dispute instructions or call the No Surprises Help Desk at 1-800-985-3059. Keep copies of the estimate, bill, and communications.
What an estimate does not promise
A cost estimate is not approval for a specific medicine, test, diagnosis, referral, or treatment. A clinician must first assess the patient and may recommend a different level of care. Self-pay pricing also does not guarantee that care will be appropriate by telehealth or available in every location.
Before scheduling with Cityworld Health, review the self-pay care page. You may also explore primary care, mental health services, and the earlier guide to questions to ask before booking self-pay primary care.
Common questions about Good Faith Estimates
What is a Good Faith Estimate in healthcare?
A Good Faith Estimate is a written or electronic list of expected charges for scheduled healthcare items and services. It helps a person who is uninsured or not using insurance understand anticipated costs before receiving non-emergency care.
Who can ask for a Good Faith Estimate?
CMS says people who do not have health insurance or who do not plan to use insurance to pay for care can usually request one. Tell each provider or facility that you are uninsured or self-pay and ask for the estimate in writing.
When should I receive a Good Faith Estimate?
CMS says that when care is scheduled 3 to 9 business days ahead, the estimate is generally due within 1 business day. When care is scheduled 10 or more business days ahead, it is generally due within 3 business days. You may also ask before scheduling; CMS says the estimate is generally due within 3 business days.
Does a Good Faith Estimate include every possible charge?
Not always. An estimate may cover only one provider or facility and may not include separately scheduled, unexpected, or medically necessary additional services. Ask whether another clinician, laboratory, imaging center, pharmacy, or facility will send a separate estimate or bill.
What if my medical bill is much higher than the estimate?
CMS says an uninsured or self-pay patient may be eligible for the federal patient-provider dispute process when a bill from a provider or facility is at least $400 more than that provider or facility's Good Faith Estimate. Keep the estimate and bill, and review current CMS instructions before acting.
Is a cost estimate the same as medical advice or a promise of treatment?
No. A cost estimate describes expected charges; it does not guarantee a diagnosis, prescription, test, referral, treatment, or outcome. Clinical decisions require an appropriate evaluation and may change if new information or unexpected needs arise.