Is a verbal price quote a good faith estimate?

No. It has to be a written document with itemized services, diagnosis and service codes, expected charges, provider details, and dispute disclaimers. A verbal quote or a bare price won’t defend you in a dispute.

When is a good faith estimate due?

The clock starts at scheduling. If care is booked 3 to 9 business days out, it’s due within 1 business day. If booked 10 or more days out, or requested on demand, it’s due within 3 business days.

What triggers a patient-provider dispute?

A final bill from one provider that runs $400 or more above that provider’s estimate. The patient has 120 days and pays a $25 fee. Collections and late fees pause while the dispute is open.

Do insured patients ever need a good faith estimate?

Yes, whenever they choose not to bill insurance for a visit. That makes them self-pay under the rule, even with active coverage. The separate provider-to-plan estimate for insured patients is not yet enforced.

Do we have to include co-provider charges?

Not as of 2026. HHS is still exercising enforcement discretion on bundling. You must issue your own estimate. If you do list a co-provider’s charges, those charges become eligible for a patient dispute.

What’s the penalty for a missing estimate?

Up to $10,000 per violation. Most enforcement actions so far involved practices with no written estimate on file at all, which makes the missing document the biggest single source of risk.

How long can one estimate cover recurring care?

Up to 12 months, if it states the frequency, visit count, and per-visit cost. You reissue at the 12-month mark, or sooner if the schedule, service, or price changes.

Good Faith Estimate Compliance: The $400 Gap

Good Faith Estimate Compliance: The $400 Gap | Qualigenix