Understanding costs in advance

 

Getting cost estimates before you get care if you’re uninsured or self-pay

Beginning January 1, 2022, if you’re uninsured or don’t plan to submit your claim to your health plan, health care providers and facilities must provide you with a “good faith estimate” of expected charges before you get an item or service. The good faith estimate isn’t a bill.

Providers and facilities must give you a good faith estimate if you ask for one, or when you schedule an item or service. It should include expected charges for the primary item or service you’re getting, and any other items or services provided as part of the same scheduled experience.

For example, if you’re getting surgery, the good faith estimate could include the cost of the surgery, any lab services or tests, and the anesthesia used during the operation. But in some instances, items or services related to the surgery that are scheduled separately, like pre-surgery appointments or physical therapy in the weeks after the surgery, might not be included in the estimate.

In 2022, the estimate isn’t required to include items and services provided to you by another provider or facility, but you can ask these providers or facilities for a separate estimate. In 2023, the provider or facility will be required to provide co-provider or co-facility cost information.

Note: You could be charged more than the estimate if you get additional items or services during your visit or procedure that your doctor didn’t anticipate.

What to expect from a good faith estimate

Providers and facilities must give you:

• Your good faith estimate before an item or service is provided, within certain timeframes.

• An itemized list with specific details and expected charges for items and services related to your care.

• Your good faith estimate in writing (paper or electronic). Note: A provider or facility can discuss the information included in the estimate over the phone or in person if you ask.

• Your estimate in a way that’s accessible to you.

Need help? View an example of what a good faith estimate may include (PDF) or a detailed explainer on the good faith estimate. (PDF)

Disputing charges higher than the estimate

Once you get your good faith estimate from your provider or facility, keep it in a safe place so you can compare it to bills you get later.

If you get the bill and the charges are at least $400 above the good faith estimate, you may be eligible to start a patient-provider dispute.

Learn more about the patient-provider dispute resolution process, including eligibility requirements. View examples of good faith estimates that do and don't qualify for the dispute process. (PDF)

Insurance ID cards

 

Starting in 2022, new pricing information will be shown on any physical or electronic insurance identification card (ID) provided to you.

This will include:

• Applicable deductibles

• Applicable out-of-pocket maximum limits

• A telephone number and website where you can get help or more information

A health plan may provide additional information on their website that you can access through a Quick Response code (commonly referred to as a QR code) on a physical ID card, or through a hyperlink on a digital ID card.

​

Disclaimer:

 

The Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created, and does not include any unknown or unexpected costs that may arise during treatment. If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill. Throughout your treatment, the provider may recommend additional items or services as part of your treatment that are not reflected in this estimate. These would need to be scheduled separately with your consent and the understanding that any additional service costs are in addition to the Good Faith Estimate.

​

If your needs change during treatment, your provider should supply a new, updated Good Faith Estimate to reflect the changes to treatment, and the accompanying cost changes. You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. The Good Faith Estimate is not a contract between provider and client and does not obligate or require the client to obtain any of the listed services from the provider. You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

 

There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount. To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call HHS at (800) 985-3059. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call (800) 985-3059.

​

​

​

​

​

​

​

​

​

​

​

​