Confirm you got a GFE
You must have received the GFE in writing before the service. If you didn't, that's a separate complaint to file with CMS first.
Good Faith Estimate
Bill $400+ over your Good Faith Estimate? Dispute it.
Federal law (No Surprises Act, 2022) gives self-pay and uninsured patients the right to dispute a final bill that's at least $400 above their Good Faith Estimate. Here's exactly how.
What the GFE is
A binding-ish estimate.
If you're self-pay or uninsured (no insurance OR you're choosing not to use insurance), federal law requires providers and facilities to give you a written Good Faith Estimate of the cost of scheduled services at least 1 business day before the service (or 3 business days if you ask further in advance).
If your final bill is $400 or more above the GFE, you have the right to dispute through the CMS Patient-Provider Dispute Resolution (PPDR) process. A neutral Selected Dispute Resolution (SDR) entity reviews the case and decides who's right.
If the SDR rules in your favor, your final cost is capped at the GFE amount. The dispute fee ($25) is also refunded if you win.
Filing the dispute
Six steps. Most close in 60–90 days.
Confirm the math
Final bill minus GFE total ≥ $400 for at least one provider/facility. The threshold is per-provider, not aggregate.
File within 120 days
You have 120 calendar days from receiving the final bill to file. Miss the window and you lose the right.
Pay the $25 fee
Filing fee is $25 (refundable if you win). Pay through the CMS PPDR portal.
SDR reviews
An independent dispute resolver looks at the GFE, the final bill, and the medical record. Most cases resolve in 60–90 days.
Get the decision
Decision is binding. If you win, you owe the GFE amount. If the provider wins, you owe the bill.
FAQ
Common questions.
Do I have to be uninsured to use the Good Faith Estimate dispute?
You do not have to be uninsured to use the Good Faith Estimate dispute — self-pay patients (those who chose not to run the bill through insurance) qualify too. About 73.7% of patients who actually dispute a medical bill receive a correction (JAMA Health Forum, 2024). The key is that the bill was never submitted to insurance, the final bill is at least $400 above the GFE from one provider, and you file within 120 calendar days.
What if my insurer denied the claim and now I'm on the hook?
If your insurer denied the claim and now you're on the hook, that is an insurance appeal, not a Good Faith Estimate dispute — the GFE rule only covers bills that were never submitted to insurance. About 73.7% of patients who actually dispute a medical bill receive a correction (JAMA Health Forum, 2024). File the insurance appeal first; if the denial stands and the bill is now self-pay, then the GFE $400 rule may apply.
Is the $25 Good Faith Estimate dispute filing fee really refunded if I win?
Yes, the $25 Good Faith Estimate dispute filing fee is refunded to your payment method when the Selected Dispute Resolver (SDR) rules in your favor. CMS's FY 2025 CERT report measured a 6.55% Medicare improper-payment rate, and the same scrutiny applies to self-pay GFE overruns. Pay the $25 when you file at the CMS PPDR portal; if you win, you owe only the GFE amount and the fee comes back.
What evidence helps a Good Faith Estimate dispute?
The evidence that helps a Good Faith Estimate dispute most is the original GFE document, the final itemized bill, any written communication from the provider explaining the increase, and the medical record showing what services were actually performed. About 73.7% of patients who actually dispute a medical bill receive a correction (JAMA Health Forum, 2024). The SDR compares the GFE estimate to the bill line-by-line, so the cleaner your document set, the stronger the case.
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