What must be included in a Good Faith Estimate under the No Surprises Act?

Question

When receiving care from an out-of-network provider, you are entitled to a written Good Faith Estimate before services begin. This document must clearly list the specific services anticipated, the estimated cost for each service, and the provider's name, credentials, and tax ID. It serves as a baseline to compare against the final bill to ensure no unexpected charges are added.

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A written Good Faith Estimate under the No Surprises Act must include the specific services anticipated, the estimated cost for each item, and the provider’s identifying details.Itemized Costs and Codes: The estimate must list each anticipated service with its expected charge, using CPT (Current Procedural Terminology) codes where applicable to ensure clarity and standardisation across providers.Provider Identification: You are entitled to see the clinician’s full name, professional credentials, and the practice’s tax identification number, as mandated by federal disclosure standards.Timeline and Updates: The document should specify the expected dates of service and include clear instructions on how to request an updated estimate if the scope of care changes unexpectedly.Dispute Protections: Under 2026 enforcement guidelines, if your final bill exceeds the Good Faith Estimate by $400 or more, you have a federal right to dispute that charge through the No Surprises Help Desk.Scope of Eligibility: This requirement protects uninsured individuals and those who opt out of insurance, applying specifically to non-emergency or unplanned emergency care from out-of-network providers.Requesting this baseline ensures you can compare the final invoice to the original projection without encountering hidden billing surprises.

What must be included in a Good Faith Estimate under the No Surprises Act?

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