Who Must Give You a Good Faith Estimate, and By When

If you are uninsured or paying for care yourself, one provider or facility — the one that first receives your request and is (or would be) responsible for scheduling your primary item or service — must send you a written good faith estimate. Under 45 CFR 149.610, that entity must meet one of three deadlines, depending on how far out the service is scheduled or when you asked for the estimate.

This original record-reading guide is a general reading aid, not cited evidence. It does not depict a source record; the article text and source links provide the facts.

Key points

• One entity is responsible: the provider or facility that received your initial request and is, or would be, responsible for scheduling the primary item or service (45 CFR 149.610).
• If your service is scheduled at least 3 business days out, the estimate is due within 1 business day of scheduling (45 CFR 149.610).
• If your service is scheduled at least 10 business days out, the estimate is due within 3 business days of scheduling (45 CFR 149.610).
• If you ask for an estimate without an item or service being scheduled yet, it is due within 3 business days of your request (45 CFR 149.610).
• These deadlines apply to estimates requested, or to items/services scheduled, on or after January 1, 2022 (45 CFR 149.610).

The responsible party

The regulation places responsibility on a single, identifiable party, defined as “the provider or facility who receives the initial request for a good faith estimate from an uninsured (or self-pay) individual and who is or, in the case of a request, would be responsible for scheduling the primary item or service” (45 CFR 149.610).

The three deadlines

The regulation ties the deadline to how the primary item or service was scheduled, or to when you made the request, whichever applies.

Scheduled at least 3 business days out. “When a primary item or service is scheduled at least 3 business days before the date the item or service is scheduled to be furnished: Not later than 1 business day after the date of scheduling” (45 CFR 149.610).

Scheduled at least 10 business days out. “When a primary item or service is scheduled at least 10 business days before such item or service is scheduled to be furnished: Not later than 3 business days after the date of scheduling” (45 CFR 149.610).

Requested before anything is scheduled. “When a good faith estimate is requested by an uninsured (or self-pay) individual: Not later than 3 business days after the date of the request” (45 CFR 149.610).

When these deadlines apply

These timing rules are not open-ended. “The requirements of this section are applicable for good faith estimates requested on or after January 1, 2022 or for good faith estimates required to be provided in connection with items or services scheduled on or after January 1, 2022” (45 CFR 149.610).

Scope and exclusions

This explainer covers only who must send the estimate and by which of the three deadlines, for uninsured or self-pay patients. It does not address what your final bill will turn out to be — a good faith estimate is not a bill. A higher final bill than the estimate is a separate matter not covered here. Finally, none of this applies if you have insurance — this section of the regulation applies only to uninsured or self-pay individuals.

Source links

• eCFR — 45 CFR 149.610 Good Faith Estimates