If you don’t have health insurance, or if you choose to pay for care without using it, your doctor or hospital is required by federal law to provide you with a price estimate for your scheduled care and to be held accountable for that amount. This is known as a good-faith estimate.
Maybe you don’t have health insurance. Or maybe you’ve decided, for various reasons, to pay for a healthcare service yourself without filing a claim with your health insurance plan.
In situations like those, it’s especially important to know how much you’ll be expected to pay. Under a law known as the No Surprises Act, you have the right to receive a good-faith estimate for scheduled care.
Importantly, if you meet certain qualifications, the law gives you the right to dispute the bill, that is, to question whether you are responsible for paying the excess amount, if you are charged $400 or more above the estimate. Here’s what to expect from your good-faith estimate:
The estimate will be itemized. You will receive a list of charges for the scheduled services, including facility fees, hospital fees and room and board. Related items like medical tests, prescription drugs and medical equipment should also be included.
You should receive the estimate within a specific time frame. You can expect to receive the estimate within one to three business days after you schedule the service, depending on how far in advance you scheduled it. These timelines were developed to give you time to make an informed decision about whether to go ahead with the service.
The estimate may not include all the items involved in a care episode. Items or services related to your care that are scheduled separately, such as pre-surgery appointments or, physical therapy after surgery.
Also, you may need to request more than one good-faith estimate; for example, you’ll want estimates from both your surgeon and the hospital if you’re scheduled for surgery. or care from another provider may not be included. Also, keep in mind that items or services that your doctor didn’t anticipate may be needed.
If you have questions after you receive the estimate, ask your doctor or hospital to explain it over the phone or in person. Save a copy of the estimate in case of a dispute.
Beginner tip
For hospital services, be sure to ask if a self-pay discount is available. These discounts are only available to patients who are uninsured or paying in full for their care.
Advanced tip
You may only dispute a bill that is $400 (or more) higher than your good faith estimate if you told your provider that you weren’t using insurance to pay for your care before you received it. Other restrictions apply.
More information about disputing a bill is available from the Centers for Medicare & Medicaid Services, the federal agency responsible for enforcing the No Surprises Act.
Bonus tip
You can ask for an estimate even if you have insurance. This document is called an “advanced explanation of benefits” and includes the same information an estimate does.
