Good faith estimates, when the difference is disputable, and how to raise it.
A cost estimate is a projection, and actual care can legitimately differ from what was planned. But a large unexplained gap between an estimate and a final bill is a fair thing to question, and in some cases federal protections apply.
If you are uninsured or paying out of pocket, federal law generally entitles you to a written good faith estimate before scheduled non-emergency care.
If your final bill is substantially higher than that estimate, generally by $400 or more, you may be able to dispute the difference through a federal patient-provider dispute resolution process.
Before disputing, ask directly: "My good faith estimate was [amount] and the final bill is [amount]. Can you explain what services differed from the estimate?"
Sometimes there is a clear clinical answer. Sometimes the gap reveals a charge worth reviewing on its own.
The good faith estimate right primarily covers uninsured and self-pay patients. If you have insurance, compare the bill to your EOB instead and confirm the claim was processed correctly, which is a different question with a different fix.
Save every estimate you receive, in writing, along with the date. Without the document, the conversation becomes a matter of recollection rather than record.
Good faith estimate rights apply primarily to uninsured and self-pay patients, and dispute eligibility depends on specific thresholds and timelines. This guide is general information, not legal advice.
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