No Surprises Good Faith Estimate — Use the $400 Rule to Challenge Self-Pay Medical Bills
What Is It?
Under the No Surprises framework, uninsured or self-pay patients must receive a Good Faith Estimate before scheduled services or on request. If the bill is at least $400 higher than the estimate, a federal dispute process may be available.
What Most People Don’t Know
- The provider must give the estimate even if you only request it and do not schedule yet.
- The dispute right is tied to a $400 difference above the expected charges.
- This is specifically useful for uninsured or self-pay patients.
Frequently Asked Questions
Do I have to be uninsured to use this?
A: It also applies to self-pay consumers who do not plan to use insurance for the service.
How far off does the bill need to be?
A: CMS states that the patient-provider dispute process is available when the bill is at least $400 more than the expected charges on the Good Faith Estimate.