What is a good faith estimate under the No Surprises Act?
A good faith estimate (GFE) is a written estimate of expected charges that healthcare providers and facilities must give to uninsured or self-pay patients under the federal No Surprises Act. It applies when such a patient schedules an item or service, or asks for an estimate. The rule took effect on January 1, 2022, and is enforced by HHS and states.
- Applies to uninsured and self-pay patients, including insured patients choosing not to use insurance.
- Due within set deadlines after scheduling or a request; patients can ask before booking.
- Providers must post a notice about the right to an estimate on their website and in the office.
- Patients can dispute bills that are $400 or more above the estimate through a federal process.
- Every practice welcome — retainers from $499/mo, Goals-Driven engagements, Performance-Linked Payout Models available.
- Dallas, Texas LLC
- US client team · Central Time (CST)
- 25+ US healthcare clients
- BAA signed with every client
- HIPAA compliance training across client and delivery teams
- Contracts and invoices in USD
-
Primary Care · North Dallas, TXCase study →
-
MedSpa · North Dallas, TX
-
Skin Care · Beverly Hills, CA
-
Dental · Christiansburg, VACase study →
-
Pediatrics · Blacksburg, VACase study →
-
Pediatric Dentistry · Blacksburg, VACase study →
-
Dental · Roanoke, VACase study →
-
Functional Medicine · Telehealth · USACase study →
“They were able to get all my ideas and work with me over a period of three to four months and create this amazing website. It's super customized, very modern, and it incorporates all the elements that I had wanted — the patient portal, nice pictures, a very interactive website, patient reviews. I would highly recommend their company to anyone who wants to make an excellent website.”
What the rule requires
The No Surprises Act, part of the Consolidated Appropriations Act, 2021, created protections against surprise medical bills. One part requires providers and facilities to give good faith estimates to people who are uninsured or who will not file a claim with their insurance.
The estimate must list the expected items and services, with diagnosis and service codes where relevant, and expected charges. Timing depends on when care is scheduled: if a service is scheduled at least 3 business days ahead, the estimate is due within 1 business day; if scheduled at least 10 business days ahead, within 3 business days; and if the patient simply asks, within 3 business days. Practices must also make information about the right to a GFE available in clear language, including on their website and in the office.
If the final bill is at least $400 more than the estimate for any provider or facility, the patient can start the federal patient-provider dispute resolution process. Some states have their own estimate laws that add requirements.
How it applies to practice marketing
- Website notice: self-pay heavy practices such as med spas, cosmetic surgery, dental and IV clinics should show the GFE notice clearly.
- Price advertising: advertised prices and "starting at" figures should be consistent with the estimates the practice gives.
- Consult flows: booking and consult pages can explain how and when estimates are provided.
- Packages and memberships: estimates still need to reflect the care scheduled.
For self-pay models, see self-pay vs insurance marketing. Membership practices should also read the membership marketing guide and membership terms guide.
Common mistakes and limits
Do not confuse this with the med spa "good faith exam", also abbreviated GFE. That is a clinical assessment before treatment and is covered in our good faith exam guide. Another mistake is thinking the rule only applies to hospitals. It applies broadly to licensed providers and facilities, including many cash-pay practices.
Some parts of the rule, such as estimates that combine charges from co-providers, have had enforcement delays. Rules and federal guidance can change, so check current CMS guidance and confirm your process with your compliance or legal team. Train front-desk staff too: they are often the first to be asked how much care will cost, and their answer should point to the written estimate process.
Related pages from the US team
Self-pay vs insurance marketing
How payment model shapes clinic marketing.
Good faith exam for med spas
The clinical GFE, not the cost estimate.
Medical practice website checklist
Notices and pages every practice site needs.
US healthcare marketing glossary
Every term, defined in plain English.
Every practice welcome — Goals-Driven engagements from $499/mo
We benchmark your last 90 days, agree monthly goals with you, and track them live on Ichelon Agency OS with a report every Monday. Performance-Linked Payout Models are available. Our US leadership is based in Dallas, and strategy calls run in US business hours.
Common questions
Who must receive a good faith estimate?
Uninsured patients and self-pay patients, meaning people with insurance who choose not to have a claim submitted. Providers must give the estimate when such a patient schedules an item or service, or when the patient asks for one.
When is a good faith estimate due?
Within 1 business day if the service is scheduled at least 3 business days ahead, and within 3 business days if it is scheduled at least 10 business days ahead or if the patient asks for an estimate. These are federal No Surprises Act timelines.
What happens if the bill is higher than the good faith estimate?
If the bill is at least $400 more than the estimate for a provider or facility, the uninsured or self-pay patient can use the federal patient-provider dispute resolution process. Some states have additional remedies.
Is a good faith estimate the same as a med spa good faith exam?
No. A good faith estimate is a cost estimate required by the No Surprises Act. A good faith exam is a clinical assessment some states require before aesthetic treatments. Both are often shortened to GFE.
A note on this guide: it explains marketing practice, not legal advice. Rules on privacy, advertising and insurance change and vary by state, so confirm anything compliance-related with your own counsel.
Is your self-pay pricing and website notice in order?
Book a 30-minute call. We'll review price messaging and website notices for your self-pay services.