Good faith estimate (GFE)

The estimate is owed before the care, not after it. When a patient who has no insurance, or has it but is not using it, schedules care at least 3 business days ahead, or asks for an estimate, the provider has to give one in writing¹. Care booked 3 to 9 business days out needs the estimate within 1 business day of scheduling; care booked 10 or more business days out, within 3 business days¹. Care scheduled 0 to 2 business days ahead does not trigger the requirement. The estimate itemizes the items and services expected for the care and the charge for each.

The estimate then becomes the yardstick for the bill. If a provider’s final charges are at least $400 more than that provider’s estimate, the patient can dispute the bill through the federal patient-provider dispute resolution process, starting within 120 days of receiving the first bill². HHS is not yet enforcing the part of the rule that asks for one estimate to include charges from co-providers and co-facilities, so each provider stands behind its own figures.

The mistake is treating the estimate as a front-desk form. Build it from your self-pay fee schedule and the codes the care is actually expected to need, keep a copy with the account, and compare it with the final bill before the statement goes out. A bill heading for $400 or more above the estimate deserves a call to the patient, and a look at what changed, before it is sent.