Insights
What Is the Good Faith Estimate Process for Self-Pay Patients?
Practices must give uninsured or self-pay patients a good faith estimate of expected charges for scheduled services. Learn what to include and when.
Under the No Surprises Act, practices must provide uninsured and self-pay patients a good faith estimate of expected charges when services are scheduled or requested. The estimate lists anticipated items and services, provider details, and expected cost ranges, helping patients make informed decisions before care. MB Claims supports practices with compliant patient billing workflows that align with federal guidance.
Which patients must receive an estimate?
Patients who are uninsured or who plan to self-pay (not using insurance for the scheduled service) must receive a good faith estimate. The requirement applies when the patient schedules a service at least three business days in advance, when the patient explicitly asks for an estimate, or when the patient is not billing any insurance for the encounter.
Patients who have coverage but choose to self-pay for privacy or high-deductible reasons still qualify. Deliver the estimate at scheduling or upon request, no later than one business day after scheduling for services scheduled three or more days out, or the day of scheduling for services within three days. The estimate serves as a planning tool and helps patients compare options or prepare financially.
What must the estimate include?
The estimate must list the patient's name and date of birth; the provider's name, NPI, and tax ID; a description of the primary service; itemized expected charges; and the date the estimate was issued.
Additional elements:
- CPT or HCPCS codes for each anticipated item or service.
- Expected facility fees if the encounter takes place at a hospital or ambulatory surgical center.
- A disclaimer that the actual bill may differ and that the patient may dispute charges that exceed the estimate by $400 or more.
- Contact information for questions and a clear statement that the estimate is not a contract or guarantee.
Use a template that your scheduling and billing teams can populate quickly. Store a copy in the patient's chart and offer a paper or electronic copy at the patient's preference.
| Element | What to Include |
|---|---|
| Patient info | Full name, date of birth |
| Provider info | Name, NPI, tax ID, practice address |
| Service description | CPT/HCPCS codes, plain-language summary |
| Expected charges | Itemized line items with cost per code |
| Disclaimer | Note that actual bill may differ; dispute process available if final exceeds estimate by ≥$400 |
| Issue date | Date estimate was generated |
| Contact | Practice phone or email for questions |
What happens if the final bill differs greatly?
If the final charge exceeds the good faith estimate by $400 or more, the patient may initiate a patient-provider dispute resolution process through a federally selected dispute resolution entity.
The dispute process:
- Patient submits a notice within 120 calendar days of the bill date.
- A certified dispute resolution entity reviews documentation from both sides.
- The entity issues a binding payment determination within 30 business days.
To avoid disputes, document any changes in scope during the visit (added procedures, different diagnosis requiring extra testing) and communicate cost changes to the patient before proceeding. Update the estimate if the care plan shifts significantly and the patient agrees to continue. Keep detailed notes of informed consent discussions tied to cost changes.
How MB Claims handles this
MB Claims provides medical billing support that aligns with HIPAA and federal patient billing guidance, helping practices build compliant workflows for self-pay estimates and documentation. Our team works with your scheduling and billing staff to design a good faith estimate template that includes all required elements, train front-desk personnel on when to generate and deliver estimates, track estimate delivery in your practice management system, and document changes in service scope that affect final charges.
We coordinate patient billing processes that fit your EHR and scheduling tools, ensuring estimates are delivered on time and include the necessary disclaimers and contact information. MB Claims signs a BAA with every client and provides ongoing support to keep workflows aligned with current federal guidance. We do not provide legal advice; practices should review the No Surprises Act requirements with their compliance advisor to confirm facility-specific obligations and state-level rules that may apply.
Frequently asked questions
Do insured patients receive good faith estimates?
No. The requirement applies only to uninsured patients or those who choose to self-pay and not file insurance for a specific service.
When must the estimate be delivered?
For services scheduled at least three business days in advance, deliver the estimate within one business day of scheduling. For services scheduled within three days, provide it on the scheduling date.
Can a practice charge more than the estimate?
Yes, but if the final bill exceeds the estimate by $400 or more, the patient may use the dispute resolution process to challenge the difference.
What if the patient's condition changes during the visit?
Document the clinical reason for additional services and communicate the cost impact to the patient before proceeding. Update the estimate or note informed consent in the chart.
Does the estimate need to be notarized or signed?
Federal guidance does not require a signature, but some practices ask patients to acknowledge receipt for their records. Confirm current requirements with your compliance advisor.
Outsource medical billing, coding, or credentialing with a HIPAA-aligned RCM team. Request a free medical billing audit at https://www.mbclaims.com/free-medical-billing-audit/ or email [hello@mbclaims.com](mailto:hello@mbclaims.com).
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