Good Faith Estimate
A written estimate of expected charges for scheduled healthcare services that uninsured or self-pay patients have the right to receive under the No Surprises Act, effective January 1, 2022.
Good Faith Estimate is a term from U.S. hospital cost and quality reporting — the field that produces the CMS Hospital Compare program, the Medicare Inpatient Payment files, and the patient-facing tools built on top of them. The definition below covers what the term means in CMS files, what it does not mean, and how it interacts with the other measures CMS publishes. On the LakeQuality value rubric, Good Faith Estimate is one of the inputs (directly or indirectly) to the combined cost-and-quality grade. Understanding how the term is computed at CMS — what counts and what does not — is part of reading hospital pages defensibly.
Each hospital page on LakeQuality surfaces the specific Good Faith Estimate value for that facility (when CMS reports one), so the general definition here translates into a concrete data point on the per-hospital pages you actually use.
How It Works
Since January 1, 2022, the No Surprises Act requires healthcare providers and facilities to furnish a Good Faith Estimate (GFE) of expected charges to every uninsured or self-pay patient scheduling services, and to provide a GFE on request to patients not using their insurance. The GFE must be provided in writing (paper or electronic) within specified timeframes based on when the service is scheduled: for services scheduled at least 3 business days in advance, the GFE must be delivered within 1 business day of scheduling; for services scheduled at least 10 business days in advance, within 3 business days; for services requested rather than scheduled, within 3 business days of the request. The GFE must include: patient name and date of birth, primary service description and diagnosis codes, itemized list of expected services with CPT/HCPCS codes and expected charges, provider name and tax ID, disclaimers about potential variation, and information about the patient-provider dispute resolution process. Scheduled services typically included are elective surgery, imaging, labs, physician visits, therapy sessions, and outpatient procedures. If the final bill exceeds the GFE by $400 or more for any single provider, the patient can initiate a patient-provider dispute resolution (PPDR) process through an independent Selected Dispute Resolution Entity (SDRE) certified by CMS, paying a $25 administrative fee. The SDRE reviews the dispute and issues a binding determination, which may reduce the bill to the GFE amount, split the difference, or uphold the original charges if the provider demonstrates valid reasons. Co-provider GFE bundling (including anesthesia, pathology, radiology) was delayed indefinitely by CMS in 2022 due to implementation complexity. Enforcement has been limited: CMS can impose civil monetary penalties of up to $10,000 per violation, but most cases resolve through patient education and hospital compliance corrections.
Related Terms
- No Surprises Act (NSA), A federal law effective January 1, 2022 that prohibits surprise billing for most emergency services and out-of-network services provided at in-network facilities, and creates Good Faith Estimate and dispute resolution protections.
- Hospital Price Transparency, A federal rule (effective January 1, 2021) requiring all U.S. hospitals to publicly display their prices, including chargemaster rates, negotiated rates with each insurer, and cash-pay discounts.
- Cash-Pay Rate (Discounted Cash Price), The price a hospital charges self-pay or uninsured patients who pay directly, often substantially lower than both the chargemaster and some commercial negotiated rates.
- Charity Care (Financial Assistance), Free or reduced-cost hospital care provided to patients who cannot afford to pay, required of all 501(c)(3) nonprofit hospitals under IRS Section 501(r) and frequently offered voluntarily by for-profit and government hospitals.
- Shoppable Service, A common, non-urgent medical service that patients can plan and price-compare in advance, required by CMS to be listed with plain-language descriptions and prices on every hospital's website.
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About This Definition
This definition is part of the HospitalCostData Hospital Pricing Glossary, 47 terms explaining hospital costs, quality ratings, and healthcare billing. Written for patients, journalists, researchers, and healthcare professionals.