Key points
- Uninsured and self-pay patients, including insured people who choose not to use their coverage, must be given a good faith estimate of the cost of care.
- If a provider's or facility's total billed charges are at least $400 more than its estimate, you can dispute the bill. Start within 120 calendar days of receiving the initial bill. The fee is $25 as of 11 November 2026.
- While the dispute is pending, the provider must not move the bill into collection, and must suspend late fees.
- This process is not for insured patients using their insurance. The matching rule for insured patients has not been put in place.
If you do not have insurance, or you choose not to use it for a service, ask for a good faith estimate before the care. If the final bill from a provider or facility is $400 or more above its estimate, you may be able to dispute the bill. Keep the estimate, because the dispute depends on it.
What this means
A good faith estimate is a written estimate of what care will cost. Under the federal No Surprises Act, it must be given to uninsured and self-pay patients. That includes people who have insurance but choose not to use it for that service.
The estimate must arrive on a schedule:
- within 1 business day of scheduling, if the service is scheduled at least 3 business days ahead
- within 3 business days of scheduling, if it is scheduled at least 10 business days ahead
- within 3 business days of a request
The estimate is the benchmark for the dispute. If a provider’s or facility’s total billed charges are at least $400 more than that provider’s or facility’s estimate, you can start a dispute with a federal process.
This is for self-pay patients. Insured patients using their coverage are not in this process. The No Surprises Act also calls for an advanced explanation of benefits and a good faith estimate for insured patients, but that has not been put in place. The federal regulatory agenda listed a proposed rule with a target of September 2026, and as of 11 November 2026 we found none published.
What to do
- Say you are paying yourself (your step). When you schedule, or when you ask the price, say you are uninsured or not using insurance. Ask for the good faith estimate in writing.
- Check it arrives on time. Use the schedule above. If it does not, ask again in writing and keep the request.
- Keep the estimate with your records. Note each provider or facility on it. A hospital, a surgeon and a lab may each give their own.
- When the bill comes, compare it with the estimate (your step). Compare each provider’s or facility’s total billed charges with that provider’s or facility’s estimate. Do not add them together.
- If a total is $400 or more over, start a dispute. Start within 120 calendar days of receiving the initial bill. The administrative fee is $25 as of 11 November 2026. The Centers for Medicare & Medicaid Services (CMS) explains how to start on its page for disputing a medical bill, which also gives the current fee. Check the date on your bill, which controls.
- Tell the provider you have started. While a dispute is pending, the provider or facility must not move the bill into collection or threaten to, should stop collection efforts already begun, and must suspend late fees. Send the provider a copy of your dispute notice and ask for confirmation.
- Wait for the decision. The dispute resolution entity must decide within 30 business days of receiving the required information.
- Complain if a provider ignores the rules. Call the No Surprises Help Desk at 1-800-985-3059 or use the online complaint form. CMS says help is available in English, Spanish and more than 350 other languages. We could not confirm the Help Desk’s hours.
What the provider may say, and what to say back
“You are insured, so we do not give estimates.” I am not using my insurance for this service. Please treat me as a self-pay patient and send me a good faith estimate.
“The estimate is only a guess.” It is the written estimate the federal rule requires. I will keep it, and I may use it if the bill is $400 or more over.
“This bill is in collections.” I have started a dispute with the federal process. Please stop collection efforts and suspend late fees, and confirm in writing.
The rule
An uninsured or self-pay patient may dispute a bill when a provider’s or facility’s total billed charges are at least $400 more than that provider’s or facility’s good faith estimate. The request must be started within 120 calendar days of receiving the initial bill, and there is an administrative fee ($25 as of 11 November 2026). See Code of Federal Regulations (CFR), title 45, section 149.620.
Watch for
- “Everyone can dispute a bill $400 over an estimate.” Not true. The process is for uninsured and self-pay patients.
- A consent form is a different estimate. If a provider asks you to give up surprise-billing protections for a scheduled service, the notice must include a good faith estimate of charges and say that consent is optional. See surprise bills. Some services can never be waived, such as emergency medicine, anesthesiology and radiology.
- A different clock for the hospital. Financial assistance has its own deadline. See hospital financial assistance.
- State law may add more. Our state pages list state surprise-billing rules where we have them.
What next
- Surprise bills: what to do if you used insurance and an out-of-network provider billed you.
- A bill is not an Explanation of Benefits: match any bill to your plan’s statement before paying.
- Get a hospital bill reduced: all the pages on this topic.