Good faith estimates and the payment dispute process
If you pay for care yourself, you can ask for a price estimate in advance. If the final bill is far higher, there is a dispute process.
Checked against official sources: October 30, 2026.
Your right to an estimate
- If you don't have insurance or won't use it, providers and facilities must usually give you a written good faith estimate. You get it when you schedule care at least 3 business days ahead or when you ask. You do not get one for emergency care.
Law: 42 U.S.C. 300gg-136; 45 CFR 149.610
- The estimate is due 1 business day after scheduling if care is at least 3 business days away, 3 business days after scheduling if it is at least 10 business days away, and 3 business days after you ask.
Law: 45 CFR 149.610(b)(1)(vi)
- An estimate currently covers one provider or facility. Ask each provider and the facility for its own estimate, for example the surgeon and the hospital.
Law: CMS, Rights without insurance
When the bill is much higher
- If one provider's or facility's bill is at least $400 more than its good faith estimate, you can use the federal patient-provider dispute resolution process. You must start within 120 calendar days of the date on the first bill. An independent reviewer decides what you pay.
Law: 45 CFR 149.620(a)(2)(ii), (c)(1)
- The dispute costs a $25 administrative fee, which is not refunded. If the reviewer decides in your favor, the $25 is taken off what you owe. If you and the provider settle during the dispute, the provider must lower your bill by at least half the fee ($12.50).
Law: 45 CFR 149.620(g); CMS, Dispute a bill
While the dispute is open
- While the dispute is pending, the provider must not send the bill to collections or threaten to, must stop collection if it already started, and must not add late fees.
Law: 45 CFR 149.620(c)(5)
- Disputing cannot raise what you owe.
Law: CMS, Dispute a bill
Price lists and where to complain
- Every hospital must post online a machine-readable file of all its standard charges, and a consumer-friendly list of at least 300 shoppable services (or an online price estimator tool). You can complain to CMS if a hospital has not posted this information.
Law: 45 CFR 180.40, 180.50, 180.60
States with their own ground ambulance protection
Before you act
Keep the estimate and the final bill side by side, with the dates. Write down who gave you the estimate and when, and check the amounts against the deadlines above before you start a dispute.
Quick answers
What is a good faith estimate?
If you don't have insurance or won't use it, providers and facilities must usually give you a written good faith estimate.
When can I dispute a bill that is higher than the estimate?
If one provider's or facility's bill is at least $400 more than its good faith estimate, you can use the federal patient-provider dispute resolution process.
Is collection paused while a dispute is open?
While the dispute is pending, the provider must not send the bill to collections or threaten to, must stop collection if it already started, and must not add late fees.
Free help
Free help can look at your bill and your letters. Legal aid groups, state insurance departments and the federal help desk do not charge for this.