Your bill came in over your Good Faith Estimate: what you can do
If you are uninsured or self-pay and a provider billed you at least $400 more than their Good Faith Estimate, federal law lets you take the bill to an independent reviewer. The window is 120 calendar days from the first bill and the fee is $25, refunded against your bill if you win.
| What | The rule |
|---|---|
| Who it is for | Uninsured or self-pay patients who received a Good Faith Estimate |
| Threshold | The provider billed at least $400 more than their own estimate |
| Deadline | 120 calendar days from the date on the initial bill |
| Fee | $25, credited against what you owe if the reviewer decides for you |
| Who decides | An independent third-party reviewer, not the provider |
| Applies per | Provider or facility — compare each estimate against its own bill |
What a Good Faith Estimate is
If you are uninsured or choosing not to use insurance, a provider must give you a written estimate of expected charges for scheduled care, and must provide one on request. It is not a quote in the contractual sense, but it is not decorative either: it is the document the federal dispute process measures the final bill against.
The $400 threshold, precisely
The dispute process opens when a provider or facility bills you at least $400 more than that provider's Good Faith Estimate for the care. It is measured per provider, not against your total bill — so if three providers gave separate estimates, you compare three pairs. That detail matters because a bill that looks $900 over in aggregate may be three providers each under the line, or one provider well past it.
The 120-day clock starts at the first bill
You have 120 calendar days from the date on the initial bill to start the process. Not from the date of service, not from when you noticed. Calendar days, not business days. Write the deadline down the day the bill arrives — the deadline calculator on the dispute letter page counts it for you and shows the days remaining.
Write to the provider first — but do not spend the window
Many bills are corrected at this stage without a formal process, and a letter costs a stamp. Ask the provider to either adjust to the estimate or explain, item by item, what changed. Give it a few weeks. But treat day 90 as your hard trigger: if nothing has moved, file the federal dispute then, keeping a month of margin rather than discovering on day 121 that the option has closed.
What the reviewer does
An independent third party — not the provider, not your insurer, because you have none in this scenario — reviews the estimate against the bill and determines an appropriate payment. The $25 administrative fee is set deliberately low so it is not a barrier, and it comes off what you owe if the decision goes your way.
If this is not your situation
The Good Faith Estimate route is for uninsured and self-pay patients. If you have insurance and were balance-billed after emergency care, or by an out-of-network clinician at an in-network facility, that is the No Surprises Act's other protection and a different letter. If the bill is simply larger than you can pay, the nonprofit-hospital financial assistance route is usually more productive than either.
This page explains the mechanism. The arithmetic is one click away.
Open the letter generator →Frequently asked questions
How much over the estimate does the bill have to be?
How long do I have to dispute?
What does the dispute cost?
Do I need a Good Faith Estimate to dispute a bill at all?
Will disputing hurt my credit or send the bill to collections?
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