Short answer: A good faith estimate dispute is a federal process for people who pay for care themselves. A good faith estimate is a written list of the charges a provider expects for your care. If one provider's bill is at least $400 more than that provider's own estimate, you can ask an independent reviewer to decide what you owe. You must start within 120 calendar days of the initial bill, and the fee is $25, as of October 2026. While the dispute is open, the provider cannot send the bill to collections.
In this guide
Learn who gets a good faith estimate and what it must include
Use a decision path to see if your bill qualifies for a dispute
File a good faith estimate dispute online or by mail, step by step
Know what the provider can and cannot do while the dispute is open
What is a good faith estimate?
A good faith estimate is a written estimate of the charges you can expect for scheduled care. Providers generally must give you one if you do not have health insurance, or if you have insurance and choose not to use it. Paying without insurance is often called self-pay. The rule comes from the No Surprises Act, a federal law that took effect on January 1, 2022.
According to CMS, the federal agency that runs the No Surprises Act rules, you should get an estimate when you schedule care at least three business days ahead. You can also ask for one at any time. Business days are Monday through Friday. You do not need to use the words "good faith" when you ask.
Each good faith estimate covers one provider or facility. A provider is the doctor, lab, or other professional who treats you. A facility is a place such as a hospital or surgery center. For a surgery, you may need one estimate from the surgeon and another from the hospital. Ask each one for its own estimate in writing.
When a provider must send the estimate
The deadline for the estimate depends on how far ahead you book. The federal rule sets these timelines:
How you got care scheduled | When the estimate is due | Notes |
|---|---|---|
Scheduled 3 to 9 business days ahead | Within 1 business day of scheduling | Count only Monday through Friday |
Scheduled 10 or more business days ahead | Within 3 business days of scheduling | Ask again if it does not arrive |
You asked for an estimate | Within 3 business days of your request | You can ask before you schedule |
Emergency care | No estimate | Estimates are for scheduled care |
The estimate must be in writing and list each expected item and service with its charge. Keep a copy, and take a photo of it if you can.
When this applies to you
The good faith estimate dispute process applies to you if you paid for care yourself and got an estimate before your care. CMS calls this process patient-provider dispute resolution. It is separate from the No Surprises Act protections for people who use insurance.
Per the CMS dispute page, you may be able to dispute a bill if all of these are true:
You did not have insurance, or you chose not to use it, and you told the provider before your care
You got the care on or after January 1, 2022
You got a written good faith estimate before your care
One provider or facility billed you at least $400 more than its own estimate
The initial bill is dated within the last 120 calendar days
If you used insurance for the care, this process does not apply. Our upcoming guide Out-of-Network Bill? Your No Surprises Act Rights in 2026 covers the protections for people with insurance. ⚠️ Note: [link when live: Out-of-Network Bill? Your No Surprises Act Rights in 2026]
Does your bill qualify? A decision path
Use this decision path to check a self-pay bill against its good faith estimate. Start at check 1 and stop at the first row that gives you an answer.
Check | If yes | If no |
|---|---|---|
1. Did you pay without insurance and tell the provider before your care | Go to check 2 | This process does not apply. If you used insurance, see your No Surprises Act rights for insured care. |
2. Did you get a written good faith estimate before your care | Go to check 3 | You cannot use this dispute. You can submit a complaint to the No Surprises Help Desk. |
3. Do the bill and the estimate come from the same provider or facility | Go to check 4 | Find the estimate from the provider that sent this bill, then start again. |
4. Is that provider's total bill at least $400 more than its total on the estimate | Go to check 5 | The bill is below the threshold. You can still check for errors and negotiate. |
5. Is the initial bill dated within the last 120 calendar days | You can likely start a dispute. Go to the steps below. | The deadline has likely passed. You can still check for errors and negotiate. |
Here is how check 4 works for a surgery. Say the hospital's bill is more than $400 above the hospital's own estimate. Say the surgeon's bill is less than $400 above the surgeon's estimate. Only the hospital's bill qualifies for a dispute.
How to file a good faith estimate dispute
Find your good faith estimate and the initial bill. Look for the date printed on the bill. Count 120 calendar days from that date, and write the deadline on your calendar.
Compare the bill with the estimate, one provider at a time. If the charges are hard to match, ask the billing office for an itemized bill, which lists each charge on its own line. Our guide on how to request an itemized hospital bill explains how.
Call the provider's billing office if you see an error. Ask them to correct the bill, and write down the date and the name of the person you spoke with. Keep an eye on your deadline while you wait, since a call does not pause the 120 days.
Gather what you need. CMS asks for a copy of your good faith estimate, the provider's contact information, a copy of your bill, and the $25 fee. Send copies and keep the originals.
Start the dispute online or by mail. Online, go to the CMS dispute page, select get started, and enter your email to get a one-time PIN. The online form resets after 15 minutes without activity, so have your papers ready first. To file by mail, use the billing dispute initiation form and send it with your copies.
Pay the $25 fee. The dispute does not start until the fee is paid. Online, you can pay by credit card, PayPal, or Venmo. By mail, include a money order or cashier's check; cash and personal checks are not accepted.
Keep records while the dispute is open. Save your confirmation, each letter, and notes from each call. If the provider keeps billing you or sends the bill to collections after a decision in your favor, call the No Surprises Help Desk at 1-800-985-3059.
What happens during a good faith estimate dispute?
A good faith estimate dispute is decided by an independent third-party reviewer. The federal rule calls this reviewer a selected dispute resolution entity. The reviewer is independent of the provider.
Under the federal rule, the provider has 10 business days to send the reviewer its estimate, the bill, and any records that explain the higher charges. The reviewer then has 30 business days to decide. These timelines can be extended in some cases.
While the dispute is open, CMS says the provider or facility cannot:
Send your bill to collections, or threaten to
Collect late fees on the unpaid bill until the process ends
Take action against you because you filed a dispute
If the bill is already in collections, the provider must stop trying to collect until the dispute is resolved. CMS also says "your costs won't increase if you dispute your bill."
What can the decision be?
The reviewer looks at each item on the bill and decides what you should pay for it. The outcome depends on whether the provider can show that the extra charges were medically necessary and could not have been foreseen when it wrote the estimate.
Situation on the bill | What you pay for that item |
|---|---|
Charge is on the estimate and is no higher | The billed amount |
Charge is higher than the estimate, and the provider cannot explain why | The amount on the estimate |
Charge is higher than the estimate, and the provider shows it was needed and unforeseen | The lower of the bill or a typical payment amount from an independent database, but at least the estimate |
Charge is not on the estimate, and the provider cannot explain why | $0 |
Charge is not on the estimate, and the provider shows it was needed and unforeseen | The lower of the bill or a typical payment amount from an independent database |
If the reviewer lowers your total, the provider must also take the $25 fee off what you owe. The decision is binding on both sides, which means both sides must follow it. You and the provider can still agree on a lower amount.
You and the provider can also settle before the reviewer decides. If you settle, the provider must lower the bill by at least $12.50, which is half the fee. Paying part of the bill while the dispute is open does not count as agreeing to a settlement.
What if you do not qualify?
A bill that falls outside the dispute rules may still be lowered. Billing errors are common: industry research finds that 40% of medical bills contain errors. An itemized bill is the place to start.
You may also qualify for income based discounts. Hospitals often call this financial assistance or charity care. Ask the billing office whether it offers income based discounts and how to apply. You can also ask the billing office for a reduced balance or a payment plan. Our upcoming guide Medical Bill Negotiation Scripts: What to Say on the Call has lines you can use on that call. ⚠️ Note: [link when live: Medical Bill Negotiation Scripts: What to Say on the Call]
If a provider did not give you a good faith estimate when it should have, you can submit a complaint. Call the No Surprises Help Desk at 1-800-985-3059, or use the CMS complaint page.
How Granted can help with a bill over your good faith estimate
Granted reviews your self-pay bill against your good faith estimate, one provider at a time. We check whether a bill passes the $400 test and how many days are left before the 120-day deadline. We also look for billing errors and check whether you may be eligible for income based discounts. If a bill looks wrong, we contact the billing office to request an itemized bill and a corrected bill.
⚠️ Note: [need product detail: whether Granted files the federal dispute or acts as the reader's authorized representative on the CMS form; until confirmed, this post does not say we do]
If you are looking at a bill like this one, upload it and get a second look before you pay. Free to start. You only pay if we lower your bill. Check your bill
Frequently asked questions about good faith estimate disputes
What is a good faith estimate dispute?
A good faith estimate dispute is a federal process for people who paid for care without insurance. If one provider bills you at least $400 more than its own good faith estimate, an independent reviewer can decide what you owe. CMS calls this patient-provider dispute resolution. It costs $25 to start, as of October 2026.
How much over the good faith estimate does a bill have to be to dispute it?
A bill has to be at least $400 more than the good faith estimate to dispute it. The $400 is measured for one provider or facility at a time, using that provider's own estimate. Overages from different providers on the same visit cannot be added together to reach $400.
How long do you have to dispute a bill that is higher than the good faith estimate?
You have 120 calendar days to dispute a bill that is higher than the good faith estimate. CMS says the initial bill must be dated within the last 120 calendar days, which is about four months. To be safe, count from the date printed on the first bill, and file well before the last day.
Can a provider send my bill to collections during a dispute?
A provider cannot send your bill to collections while a good faith estimate dispute is open, and it cannot threaten to. If the bill is already in collections, the provider must stop collection efforts until the dispute ends. The provider also cannot collect late fees on the unpaid bill during the process.
What if I did not get a good faith estimate?
If you did not get a good faith estimate, you cannot use the dispute process, because it compares your bill with a written estimate. You can submit a complaint to the No Surprises Help Desk at 1-800-985-3059. You can still ask for an itemized bill, check for errors, and apply for income based discounts.
What does Granted charge to help with a bill over the estimate?
Granted is a digital health advocate that reviews medical bills, finds billing errors, negotiates with billing offices, and checks your eligibility for income based discounts. It is free to start, and you only pay if we lower your bill. Our fee is 10% of the negotiated savings, capped at $300 per bill.
Key terms in this post
Good faith estimate: a written estimate of expected charges that providers give people who pay for care without insurance.
Self-pay: paying for care yourself, without using health insurance.
Patient-provider dispute resolution: the federal process for disputing a self-pay bill that is at least $400 over its good faith estimate.
Provider: the doctor, lab, or other professional who treats you.
Facility: a place where you get care, such as a hospital or surgery center.
Selected dispute resolution entity: the independent reviewer that decides what you owe in a dispute.
Itemized bill: a bill that lists each charge on its own line.
Income based discounts: lower prices or forgiven bills based on your household income.
Key takeaways
People who pay for care without insurance can dispute a bill that is at least $400 more than a provider's own good faith estimate.
The good faith estimate dispute must start within 120 calendar days of the initial bill, and the fee is $25 as of October 2026.
The $400 test applies to one provider or facility at a time, so overages from different providers cannot be combined.
A provider cannot send a disputed bill to collections or charge late fees while a good faith estimate dispute is open.
If the reviewer lowers a self-pay bill, the provider must also take the $25 dispute fee off what you owe.
Sources
CMS, Dispute a medical bill (patient-provider dispute resolution): https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights/get-help/dispute-bill (checked Oct 23, 2026)
CMS, Know your rights without insurance: https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights/know-your-rights/without-insurance (checked Oct 23, 2026)
CMS, Medical bill rights: https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights (checked Oct 23, 2026)
CMS, Submit a complaint: https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights/get-help/submit-complaint (checked Oct 23, 2026)
CMS, Billing dispute initiation form: https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf (checked Oct 23, 2026)
CMS, No Surprises overview: https://www.cms.gov/nosurprises (checked Oct 23, 2026)
eCFR, 45 CFR 149.610, Good faith estimates for people paying without insurance: https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-B/part-149/subpart-G/section-149.610 (checked Oct 23, 2026)
eCFR, 45 CFR 149.620, Patient-provider dispute resolution: https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-B/part-149/subpart-G/section-149.620 (checked Oct 23, 2026)
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Last reviewed: October 23, 2026. We update this page when the rules change.
This is general information, not legal or tax advice.