The clinic asks one question before booking your MRI: “Will you be using insurance today?” You do not have coverage right now, or you have decided to pay on your own. The receptionist says the cost “depends,” and the appointment is next week.
Most people assume that is the end of the conversation. It does not have to be. If you are uninsured or paying without insurance, federal rules give you the right to a written price estimate before the care happens.
It is called a Good Faith Estimate. It does not lock in a price, but it does give you a reference point, and if the final bill comes in far above it, there is a formal way to dispute the difference.
What a Good Faith Estimate is
A Good Faith Estimate is a written estimate of the expected charges for a scheduled service, or for a service you are asking about. The requirement comes from the federal No Surprises Act, and it applies to people who are uninsured or who choose not to bill their insurance (often called “self-pay”).
The estimate is meant to list the items and services you are likely to receive, along with expected charges. It can also include services from other providers or facilities that are expected to be part of the same care, depending on the situation.
People enrolled in certain government programs, such as Medicare, Medicaid or TRICARE, generally fall outside this particular process. If that applies to you, check CMS.gov for the protections that do apply.
Figures reflect CMS guidance on Good Faith Estimates for uninsured and self-pay patients. Details and exceptions apply, so check CMS.gov for the current rules.
When you should receive it
The timing depends on when you schedule. According to CMS guidance:
You do not need to use any special wording, but it helps to be clear. Say that you are uninsured or self-pay and that you would like a Good Faith Estimate in writing.
What to check on the estimate
An estimate is only useful if it actually matches the care you are scheduled for. When it arrives, look for:
- Your name and the date it was issued
- The service you are scheduled for, described clearly
- An itemized list of expected items and services, with expected charges
- Other providers or facilities expected to be involved, where applicable
- The provider’s name and contact details
Keep a copy, paper or digital. If you later need to dispute a bill, you will generally need to show the estimate.
When the bill is much higher
Bills do not have to match an estimate exactly. Care can change once a provider sees what is needed. But there is a line. If you are uninsured or self-pay and a provider or facility bills you at least $400 more than the amount on its estimate, you may be able to use the federal patient-provider dispute resolution process.
The threshold is measured per provider or facility listed on the estimate, not for the whole episode of care combined. Here is a made-up example to show how that works:
| Provider | Estimate | Final bill | Difference |
|---|---|---|---|
| Imaging center | $800 | $1,300 | +$500 |
| Radiologist group | $250 | $400 | +$150 |
In this example, the imaging center’s bill crosses the $400 line and could qualify for dispute. The radiologist’s bill does not, even though both went up. Whether your own bill qualifies depends on the estimate you received and the current rules.
How the dispute process works
- Compare the bill with your estimate. Check each provider or facility separately and note the difference.
- Talk to the provider first. Ask why the bill is higher, and whether they will adjust it or offer a payment arrangement. Many issues get resolved here.
- Watch the deadline. CMS guidance says the dispute generally must be started within 120 calendar days of the date on the original bill.
- Start the dispute through CMS. The process is run through the federal government. There is a $25 administrative fee. Instructions are on CMS.gov.
- Ask about collections while it is pending. Rules generally limit collection activity on the disputed amount during the process, so ask the provider to note the dispute on your account.
An independent dispute resolution entity reviews the case and decides the amount you should pay. According to CMS, if the decision lowers the amount you owe, the $25 fee is subtracted from what you pay the provider.
Related: 9 Questions to Ask Before You Pay a Medical Bill
Uninsured vs. choosing self-pay
Uninsured
- No health coverage at all
- Can ask any covered provider for an estimate
- Should also ask about cash prices and financial assistance
Self-pay with insurance
- You have coverage but choose not to bill it
- Tell the provider clearly that you are paying on your own
- Ask how paying this way affects your deductible
Choosing self-pay is sometimes cheaper for a single service, but payments made outside your plan may not count toward your deductible or out-of-pocket maximum. Weigh that before deciding.
Related: Your Health Plan Has a Number That Can Cap Your Bills. Most People Never Look for It
A short script for the front desk
1. “I’m uninsured (or paying self-pay). Can you send me a Good Faith Estimate in writing?”
2. “Does it include other providers who will be involved, such as the lab or the doctor reading the results?”
3. “Do you offer a cash price or a prompt-pay discount?”
4. “Do you have a financial assistance program, and how do I apply?”
Two things people get wrong
Which situation looks like yours?
A walk-through: one hypothetical MRI
Here is how the process might look from start to finish for a made-up patient. The names, dates and prices are invented for illustration.
- Booking. Daniel is between jobs and uninsured. His doctor orders a knee MRI. When he calls the imaging center two weeks ahead, he says he is uninsured and asks for a Good Faith Estimate in writing.
- The estimate arrives. Within a few days he receives an estimate listing the scan and the radiologist’s reading, with an expected total. He saves it as a PDF and prints a copy.
- Comparing. With the estimate in hand, he calls one other imaging center and asks for its estimate too. The second one is lower, so he books there instead.
- The bill. Weeks later, the bill from the imaging center comes in close to the estimate. The radiologist’s bill also matches. Daniel asks about a prompt-pay discount and a payment plan, and pays in installments.
Nothing dramatic happened, and that is the point. The estimate let Daniel compare prices before he committed, and gave him a reference he could check the bill against.
If a provider will not give you an estimate
Most offices will provide one when asked clearly, but not every front desk is familiar with the rules. If you run into trouble:
- Ask again, in writing if possible, and say you are uninsured or self-pay and requesting a Good Faith Estimate
- Ask to speak with the billing office or practice manager rather than the scheduling desk
- Write down the date, time and name of each person you speak with
- Review the consumer information and complaint options on CMS.gov’s No Surprises Act pages
Keep in mind that the estimate is something you can ask for before you agree to care. If a provider will not give you any price information, that is useful to know while you still have time to choose another provider.
Other ways to lower a self-pay bill
A Good Faith Estimate tells you what to expect. It does not, by itself, make care cheaper. These steps can:
Related: Many Hospitals Have a Program That Can Shrink Your Bill. Few Patients Ask About It
What to keep in your records
If you ever need to dispute a bill, a clean paper trail makes the process far easier. Keep:
- The Good Faith Estimate, with the date you received it
- Every bill, including the date printed on the original bill
- Proof of any payments you made
- Notes from calls with the provider or billing office
Frequently asked questions
Who can get a Good Faith Estimate?
People who are uninsured, or who have coverage but choose not to use it for a service. People in certain government programs, such as Medicare or Medicaid, generally fall outside this process.
Is the estimate a guaranteed price?
No. It is an estimate. Final charges can differ, but a bill at least $400 above a provider’s estimate may qualify for the federal dispute process.
How long do I have to dispute a bill?
CMS guidance says you generally must start within 120 calendar days of the date on the original bill.
Does it cost anything to dispute?
There is a $25 administrative fee. If the decision lowers what you owe, CMS says the fee is subtracted from the amount you pay the provider.
Keep reading
Sources to review: CMS.gov, “Understanding the Good Faith Estimate and Dispute Resolution Process”; CMS.gov No Surprises Act consumer pages.
This article is educational information, not legal, medical or financial advice. Examples are hypothetical. Rules, thresholds and deadlines can change and include exceptions, so confirm current details on CMS.gov.