Know your rights when you aren't using health insurance
This page applies to all people in the United States who:
- Don't use health insurance
- Don’t have health insurance
The No Surprises Act is a federal law that went into effect on January 1, 2022.
Usually, if you don't have or use health insurance to pay for your care, providers must give you a good faith estimate of how much it will cost. You get the estimate when you schedule care at least 3 business days in advance or if you ask for one. You may be able to dispute your bill if it’s at least $400 more than the estimate.
Note: You won’t get an estimate during emergency care.
Get a good faith estimate
If you aren’t using insurance to pay for your care, let your health care provider know in advance. Usually, the provider must give you a good faith estimate of expected charges.
This applies when you don’t have insurance, or are choosing not to use it. You may choose not to use insurance if the service you need isn’t covered, or it’s less expensive if you pay out of pocket.
In most cases, providers and facilities must give you an estimate when you schedule care at least 3 business days in advance, or if you ask for one.
If a bill from one of your providers is at least $400 more than the good faith estimate from that provider, you can dispute your bill.
What is a good faith estimate?
A good faith estimate is a list of expected charges before you get health care items or services (procedures, supporting care) from a provider or facility.
The good faith estimate isn't a bill. You're only given one if you don't have insurance or aren’t using insurance to pay for your care.
View an example of a good faith estimate (PDF). (Note: This example is blank. The estimate you get will list details of your care.)
When can you get a good faith estimate?
You’re eligible to get a good faith estimate if you schedule care at least 3 business days (Monday through Friday) in advance. You can ask your provider directly for an estimate if they don’t give one to you.
Note: You won’t get an estimate during emergency care.
What’s included on a good faith estimate?
A good faith estimate should include expected charges for the health care items and services, including facilities fees and hospital fees.
Currently, good faith estimates only list expected charges for a single provider or facility, even if multiple providers will be involved in your care. You should request an estimate from each of your providers and the facility involved in your care.
Note: Your provider should include everything they can on the estimate. But you may need care that they didn’t anticipate. That care won’t be included on the estimate.
Example
You’re scheduled for surgery. You should request 2 good faith estimates: one from the surgeon, and one from the hospital.
The 2 estimates could include services like:
- The cost of the surgery
- Hospital fees
You may need health care items or services from other providers or facilities. You can ask them for a good faith estimate for that care.
Get a good faith estimate in writing from your provider
If you scheduled care and haven’t gotten a good faith estimate yet, ask for one in writing. You don’t need to use the specific term "Good Faith" to request an estimate.
You’ll need a good faith estimate in writing if you need to dispute your bill. You can’t use the No Surprises Act dispute process without an estimate. In that case, find an action plan to help navigate your medical billing situation. And submit a complaint to report a violation of the No Surprises Act.
Read more about good faith estimates
Save your good faith estimate to compare it to your final bill
Save your good faith estimate
Once you get your good faith estimate from your provider or facility, keep it in a safe place and take a picture with your phone (if you have one).
Compare your bill to your good faith estimate
When you get your bill, compare it to the good faith estimate.
View examples to help you know if you can dispute your bill (PDF)
Dispute a bill
You can dispute a bill if one of your providers or facilities charged at least $400 more than their estimate. An independent third party will review your bill and determine an appropriate payment.
You have to start a dispute within 120 days (about 4 months) of getting your initial bill. It's important not to delay.
Other resources
These resources can help you navigate the healthcare system.
Page Last Modified:
11/05/2024 03:38 PM