Under federal rules, patients who are uninsured or paying out of pocket are entitled to a written estimate of expected charges before scheduled care. The phrase means the provider is expected to stand behind the number.
What to do with it:
- Ask before scheduling, not at the front desk on the day of.
- Check what it includes. Ask directly whether the physician fee, anesthesia, labs and imaging sit inside the estimate or bill separately. That gap is where estimates and final bills diverge.
- Keep it. If the final bill substantially exceeds the estimate, the difference is disputable and there is a federal process for it.
Where it does not reach. Emergency care by definition has no advance estimate. That is what hospital financial assistance and the surprise billing rules handle afterward.
For a planned procedure, an estimate plus the hospital’s published price file is the closest thing to a real number available in advance.
Also called: GFE, advance cost estimate. Reference: Good faith estimate on Wikipedia — general definition, not New York specifics.
More in Glossary of health coverage and billing terms
- Coinsurance — Your percentage share of a bill after the deductible — 20% of a $4,000 procedure is $800.
- Out-of-pocket maximum — The annual ceiling on what you pay for in-network covered care. After it, the plan pays 100%.
- Network (in-network and out-of-network) — The set of doctors and hospitals your plan has contracted with. Outside it, you pay much more.
This page explains how the system works. It is not medical advice. More.