What Is a Good Faith Estimate?

Healthcare costs can be difficult for uninsured or self-paying patients to predict before care happens. The Good Faith Estimate, created under the No Surprises Act, provides clarity for patients who are uninsured or choose not to use insurance for scheduled, non-emergency care.

A clear GFE outlines the expected charges for medical services before care is delivered, which supports stronger financial transparency, reduces billing disputes, and helps patients make informed decisions as they prepare for potential expenses.

Defining Good Faith Estimates

A Good Faith Estimate is a written estimate of expected charges for a scheduled, non-emergency health care item, service, or procedure. It’s specifically for situations when a patient is uninsured or not using insurance to pay for care, as it provides a practical view of anticipated costs before services are delivered.

A GFE is not a bill. It reflects information known at the time the estimate is created, so it may not include every unexpected cost that arises during treatment.

READ MORE: Eligibility Verification and Prior Authorization

What Does a Good Faith Estimate Include?

A Good Faith Estimate provides an itemized list of expected charges connected to the scheduled service. It includes a comprehensive breakdown with specific details for each item or service, including:

• Provider fees such as charges for consultations or examinations
• Costs for laboratory services, including blood tests, pathology, or other diagnostic work
• Fees for genetic testing services or imaging services such as X-rays, ultrasounds, or MRIs
• Procedural costs like anesthesia, surgical supplies, or specialized equipment
• Facility fees covering the use of a hospital, clinic, or outpatient center
• Co-provider services from additional specialists such as radiologists, pathologists, or anesthesiologists

Together, these elements ensure that patients have a clearer picture of the financial aspects of their care before receiving services.

Good Faith Estimates generally list expected charges for a single provider or facility. If multiple providers or facilities are involved in care, or if a patient is comparing costs, multiple GFEs will also need to be provided.

What Does a Good Faith Estimate Not Include?

Some services that seem to be related can still be excluded if they are scheduled separately. Pre-service visits or post-service therapy scheduled on different dates may come with separate estimates.

A GFE may also exclude care services or items delivered by another provider or facility, or that were not anticipated before care was provided. This is one reason why coordination across care settings is essential for price transparency in healthcare.

When Should Patients Receive a Good Faith Estimate?

Providers, co-providers, and facilities are required to supply a Good Faith Estimate in 1 business day when the patient schedules care at least 3 business days in advance. If care is scheduled 10 or more business days in advance, the GFE can be provided within 3 business days.

Patients can also request an estimate before scheduling, and the provider must respond within 3 business days. Depending on the situation, the estimate may be sent directly to the patient or to the patient’s health plan.

Is a Good Faith Estimate Required for Insured Patients?

Under the No Surprises Act, providers do not need to provide a Good Faith Estimate for insured patients. A GFE is only required when a patient is uninsured or chooses not to use insurance to pay for scheduled care. If a patient plans to submit a claim to their health plan, the federal GFE requirement typically does not apply.

This is because the No Surprises Act created the GFE to address cost uncertainty for self-paying patients who lack the negotiated rate protections that come with insurance coverage. Insured patients receive different protections under the Act, including limits on balance billing and surprise bills from out-of-network providers in certain situations.

However, insured patients should still receive cost information. Many states have their own price transparency or estimate requirements that apply to all patients, regardless of insurance status. Some health systems also provide estimates as a standard practice. When patients understand their expected out-of-pocket responsibility in advance, they are better prepared to ask questions and explore payment options before services occur.

How Estimates Differ by Specialty

Good Faith Estimates vary by specialty, depending on the medical specialty and the type of care a patient receives. For example:

• Primary Care: A routine physical may include charges for the office visit itself, standard laboratory work, and any recommended immunizations.
• Oncology: A biopsy could involve multiple layers of cost, such as anesthesia, pathology services, and facility fees, in addition to the oncologist’s professional services.
• Obstetrics & Gynecology: Prenatal care often requires a combination of examinations, ultrasounds, laboratory testing, and genetic screening.

These variations highlight how a GFE adapts to the unique scope of each specialty, ensuring patients receive an estimate that reflects the full spectrum of potential services tied to their care. Because multiple providers and facilities are often involved, assembling an accurate and comprehensive GFE requires coordination across care teams.

Why Good Faith Estimates Are Important

The Good Faith Estimate is a practical step toward healthcare transparency for uninsured and self-pay patients. GFEs clarify patient costs before care is delivered, reducing confusion and allowing for better financial planning. They also provide a clear point of comparison between planned and actual costs for care, as the patient may be eligible to dispute the bill if charges are $400 or more above the GFE.

In addition, GFEs support providers by ensuring compliance with federal requirements and strengthening trust in the patient/provider relationship.

Streamlining Good Faith Estimates with Technology

Creating accurate and timely Good Faith Estimates can be challenging when information must be gathered from different systems and providers. Manual work increases the odds of incomplete itemization, missed deadlines, and inconsistent patient communication. Technology can simplify this process by automating estimates and coordinating data to ensure that patients receive complete, accurate information.

The seeQer prior authorization software by careviso is designed to support providers in generating Good Faith Estimates efficiently and in compliance with regulations. By integrating eligibility verification, patient cost responsibility, patient eligibility, and prior authorization processing into a single real-time process, seeQer helps providers deliver financial transparency to every patient, whether insured or self-pay.

READ MORE: AI in Prior Authorization: How Technology is Streamlining Access to Care

If your organization is looking to improve estimate speed, completeness, and patient confidence, schedule a seeQer demo to learn how careviso helps transform financial transparency in healthcare.