Good Faith Estimates and the $400 dispute rule

Under the No Surprises Act, if you are uninsured or choose not to use your insurance, the hospital must give you a written Good Faith Estimate on request. If the bill from that hospital or provider is $400 or more above its estimate, you can dispute it.

Who can use the dispute process

• You had no insurance for the service, or had insurance but asked the provider not to bill it.
• You got a Good Faith Estimate before the care.
• The bill from one provider or facility is at least $400 more than that provider’s estimate (each provider on the estimate is measured separately; items billed but not on the estimate count).

Deadline and fee

• Start within 120 calendar days of the date of the first bill.
• The fee is $25. If the decision lowers your bill, the fee is taken off what you owe.
• An independent dispute resolution entity chosen by HHS decides.

What the price files have to do with it

The prices on this site are the hospital’s published standard charges, not a Good Faith Estimate. They tell you what to expect and what to ask for; the estimate you get from the hospital is what the dispute process compares the bill with.

Sources: 45 CFR 149.610 and 149.620; CMS: dispute a medical bill. CMS’s No Surprises help line: 1-800-985-3059. This is general information, not legal advice.