Surprise billing
Good Faith Estimate — when the bill is much higher than what they quoted
If you're paying out of pocket for scheduled care, the provider has to give you a written Good Faith Estimate before the service. If the actual bill exceeds the estimate by $400 or more, you have a federal right to dispute the difference through the Patient-Provider Dispute Resolution process.
Federal basis
No Surprises Act — Good Faith Estimate / PPDR
45 CFR §149.610 (GFE) / §149.620 (PPDR)
Read the source →What this looks like in practice
Under the No Surprises Act, providers must give uninsured and self-pay patients a written Good Faith Estimate for scheduled non-emergency services. If the final bill is more than $400 above the GFE, the patient can file a Patient-Provider Dispute Resolution (PPDR) request with HHS within 120 days of receiving the bill. A federally-certified dispute resolution entity reviews the case for $25 patient cost (refunded if the patient prevails) and decides what amount the patient owes. The provider's bill is bound by the decision.
The GFE has to be specific: the patient's name, the service description with CPT codes and expected charges, the total expected cost, and a disclaimer that actual costs may differ. A vague 'this might cost a few thousand dollars' isn't a GFE.
How to spot it on a bill
- 01.You scheduled a procedure as self-pay or uninsured, and you got a final bill but never received a written Good Faith Estimate.
- 02.You received a GFE but the final bill is more than $400 above the estimate — for the same services rendered.
- 03.The GFE didn't include specific CPT codes or itemized expected charges.
What to write — ready-to-paste language
Replace the bracketed fields with your specific details. Send by certified mail with return receipt, or via the hospital’s patient portal if it offers documented messaging. Keep a copy.
I'm writing about my bill dated [date] for $[amount]. The Good Faith Estimate I received before the service was for $[GFE amount] — a difference of $[delta], which exceeds the $400 threshold for Patient-Provider Dispute Resolution under No Surprises Act §149.620 (45 CFR §149.620). Please send a corrected bill that aligns with the GFE, or I will file a PPDR request with HHS within 120 days as my federal right.
This is a starting point, not legal advice. Your specific situation may warrant additional details. Our scan tool drafts this letter automatically with your bill’s specifics filled in.
Skip the manual review
Our scan checks every line of your bill against this and 20+ other patterns — in 60 seconds.
Upload a photo or PDF of the bill. Every charge cross-referenced against four federal data sources, every flagged pattern paired with the right dispute letter pre-drafted with the citations and the math already inside. You sign, you mail.
- ✓Up to 5 dispute letters drafted, including this one if it applies.
- ✓Charity-care application drafted if your hospital is non-profit.
- ✓Federal-statute citations & line-item math automated.
- ✓We Found Something or You Don’t Pay.
Related scenarios
Surprise billing — out-of-network charges at an in-network facility
The No Surprises Act (2022) protects patients from out-of-network bills for emergency care and from out-of-network providers at in-network facilities. Federal law caps your liability.
ER bill from out-of-network provider — federal protection at any hospital
The No Surprises Act mandates that emergency services be billed at in-network rates, regardless of which hospital you went to or who treated you.
Common questions
What if I never got a Good Faith Estimate?
Does the GFE rule apply if I have insurance?
P.S. The dispute language above is a starting point. Bills with this pattern often have additional issues alongside it — coding errors stacked with markup, surprise bills stacked with charity- care eligibility. The scan finds all of them in one pass. Start the audit →
P.P.S.Federal law gives you these rights regardless of how the bill arrived. Insured, uninsured, in-network, out-of-network — the underlying patient-protection statutes apply.
P.P.P.S. Bills are time-sensitive. Most insurance appeals must be filed within 180 days. Charity-care discounts at non-profit hospitals are most easily applied within 240 days of the original bill. Acting earlier costs less.