The Good Faith Estimate is the most useful thing the federal government has ever handed an uninsured patient, and most people entitled to one have never heard the phrase. It is a written, itemized price for scheduled care, owed to you before the care happens, with a formal dispute process attached if the final bill blows past it. This is how it works and how to actually get one.
What the law entitles you to
The No Surprises Act, in force since January 2022, is best known for protecting insured patients from out-of-network surprise bills. Tucked inside it is a separate and much less discussed provision aimed squarely at people without coverage: if you are uninsured, or you have insurance but tell the provider you do not intend to use it for this service, you are entitled to a written Good Faith Estimate of expected charges for scheduled care.
The estimate is supposed to be itemized. It should name the primary service, list the expected items and services associated with it, and give the expected charge for each. It is a price document, not a marketing brochure.
The $400 number is the whole point
An estimate with no consequence attached is a guess. What makes this one enforceable is the patient-provider dispute resolution process: if the final billed charge exceeds the Good Faith Estimate by $400 or more, you can initiate a federal dispute rather than simply arguing with the billing office.
Two practical consequences follow. First, keep the estimate. A Good Faith Estimate you cannot produce is a Good Faith Estimate you never received, as far as the process is concerned. Second, ask for it by email or patient portal, not over the phone, for exactly that reason.
How to actually get one
"I am a self-pay patient and will not be billing insurance for this service. Under the No Surprises Act I am requesting a written, itemized Good Faith Estimate for [procedure] before I schedule. Please include the facility fee, the professional fee, anesthesia, pathology, and any expected implant or device charges. Please send it by email to [address]."
Three details in that script do the heavy lifting. Naming the statute signals that you know the request is not optional. Listing the fee categories forestalls the most common problem, which is an estimate covering the surgeon's fee and nothing else. Asking for email creates the record.
Call the billing or financial counseling department rather than scheduling. Scheduling staff frequently have never processed the request. Billing has, because billing is where the compliance obligation actually lives.
The four line items estimates leave out
An incomplete estimate is the standard failure, and it is usually incomplete in the same four places. A surgical bill is not one bill, it is three or four bills from separate entities that happen to share a building.
| Commonly omitted | Why it gets left off | What to ask |
|---|---|---|
| Anesthesia | Billed by a separate anesthesia group, often time-based rather than flat | "Is anesthesia billed separately, and by whom? Flat or per unit of time?" |
| Facility fee | The hospital or surgery center bills this independently of the surgeon | "What is the facility fee at this site of service, and does it change if I use an ambulatory surgery center?" |
| Pathology and labs | Sent out to a third-party lab that bills you directly | "Which lab receives specimens, and can I request a self-pay lab instead?" |
| Implants, hardware, devices | Priced at the hospital's markup and highly variable | "What is the device charge, and is it billed at cost, cost-plus, or list?" |
This is why an estimate that arrives as a single number should be sent back. Ask for the four lines above by name.
What the estimate is not
It is not a binding quote. It is an expected charge, and clinical reality can legitimately change it: a procedure converts from laparoscopic to open, a night in the hospital becomes two, pathology finds something. The dispute process exists to separate legitimate clinical variance from a number that was never realistic.
It is also not a substitute for shopping. An accurate Good Faith Estimate at an expensive hospital is still an expensive price. The estimate tells you what this provider will charge, not whether this provider is the right site of service. Pair it with the self-pay discount ask and a price at a freestanding surgery center before you decide anything.
The contrast worth noticing
The United States needed a federal statute, a compliance regime, and a formal dispute process to make providers tell patients the price before the procedure. It is worth sitting with how strange that is.
In most of the world's private medical markets, an itemized written price before treatment is not a legal remedy. It is the opening move of a normal commercial transaction, because the patient is the payer and the clinic competes on the number. Colombian private clinics quote all-inclusive package prices up front as standard practice for exactly that reason. When an American patient asks a Medellin clinic what a procedure costs, the question does not require a statute to answer.
That difference is not a claim about clinical quality, and it is not an argument that the price is lower, which is a separate question with a separate answer. It is an observation about who the system treats as the customer.
A quote you did not have to legislate for
If you are going through the Good Faith Estimate process because you are pricing an elective procedure, it is worth running the same request at an accredited hospital abroad in parallel. The turnaround is typically days, the quote is typically all-inclusive, and it costs you nothing to hold the two documents side by side.
We are based in Medellin and can tell you what to ask for, what should be itemized, and what to verify before you commit to anyone, here or there.
Straight answers
Who is entitled to a Good Faith Estimate?
Uninsured patients, and insured patients who tell the provider they will not be submitting the service to their health plan. If you intend to run the service through insurance, a different set of rules applies and you would be asking for an advance explanation of benefits from the plan instead.
Does it cover emergency care?
No. The estimate applies to scheduled services, which is precisely why it is worth requesting early for anything elective. Emergency care is covered by the separate balance-billing provisions of the same law, with the significant exception of ground ambulances.
What if the provider simply refuses?
Escalate from scheduling to the billing or compliance department, put the request in writing, and cite the No Surprises Act. If the provider still refuses, the federal No Surprises Help Desk accepts complaints. In parallel, treat the refusal as information: a provider unwilling to put a price in writing is telling you something about the bill that is coming.
How far in advance should I ask?
As early as possible, and before you schedule if you can. The estimate is most useful as a shopping document, and its leverage disappears once the procedure is on the calendar and you have stopped comparing sites of service.
Does the $400 dispute threshold apply per line or to the total?
The dispute process is oriented to the total billed charge from the provider compared against that provider's estimate. Since a surgical episode often generates separate bills from the facility, the surgeon, and the anesthesia group, keep an estimate from each entity rather than one document.
Can I use the estimate to negotiate rather than dispute?
Yes, and most people should try that first. An itemized estimate is the strongest negotiating document an uninsured patient can hold, because it lets you challenge specific lines instead of asking vaguely for a discount.
How to read the numbers on this page. Every dollar figure here is a typical 2026 range compiled from published provider pricing, transparent-price surgery centers, and government data. None of it is a quote, and none of it is a guarantee. Your bill depends on your case, your provider, and your state. Get a current itemized estimate in writing before you budget against anything you read here.
Not legal or medical advice. This is consumer education about billing rules and patient rights, written for people paying cash. It is not legal advice, and it is not a substitute for a licensed clinician. If you are considering care in Colombia, verify any physician on the Colombian government's ReTHUS registry and confirm accreditation at the hospital level before you commit to anything.
Disclosure. Cash Medical is operated by Scout Theory LLC. We may receive referral compensation from providers we connect patients with. It never changes the price you are quoted, and it never decides what we publish. Questions: andy@colombiamedical.co.