Your Rights to a Good Faith Estimate
Healthcare costs can often feel unpredictable, but recent regulations have taken important steps to change that. The No Surprises Act was designed to protect consumers from receiving unexpected medical bills and to bring greater transparency to healthcare pricing.
One key part of this law is the Good Faith Estimate provision, which gives patients greater visibility into the cost of their care before they receive it. For self-paying individuals, this creates a more informed and controlled healthcare experience.
What Is a Good Faith Estimate?
A Good Faith Estimate is a document provided by a healthcare provider that outlines the expected costs for medical services prior to your appointment. It typically includes charges for the provider, facility, and any additional services related to your care.
This estimate is designed to give patients predictability in how much they will be charged before services are performed. Instead of being surprised by a bill after the fact, you can review costs in advance and make informed decisions.
Your Right to Request One
Patients who are self-pay have the right to request a Good Faith Estimate for non-emergency care. In many cases, providers are required to provide this estimate when you schedule services or request it.
This right exists to help protect you from unexpected costs and to give you the opportunity to understand pricing before committing to care.
For EverTrust Health Share members, requesting a Good Faith Estimate should be a standard part of preparing for any planned medical service.
When You Should Receive Your Estimate
The No Surprises Act also establishes clear timelines for when providers must deliver a Good Faith Estimate to self-pay patients.
If your service is scheduled at least three (3) business days in advance, the estimate must be provided no later than one (1) business day after the service is scheduled. If your service is scheduled at least ten (10) business days in advance, the estimate must be provided within three (3) business days. If you request a Good Faith Estimate without scheduling a service, providers are required to deliver it within three (3) business days of your request.
Understanding these timelines helps you know when to expect your estimate and when to follow up if needed.
Why It Matters for EverTrust Members
Because EverTrust members present as self-pay patients, pricing can vary significantly between providers. A Good Faith Estimate allows you to compare costs, identify fair pricing, and avoid unnecessary or inflated charges.
It also allows EverTrust to support you before care is received by reviewing estimates, helping evaluate pricing, and identifying opportunities to reduce expenses. This proactive approach helps members make better decisions while supporting the overall health of the community.
How It Helps You Save Money
A Good Faith Estimate gives you the opportunity to ask questions and explore options before committing to care. You may find that different providers offer significantly different pricing for the same service. In many cases, outpatient or surgical centers may be more affordable than hospital-based care. Providers may also offer bundled pricing or discounts for upfront payment.
By comparing options and understanding costs in advance, you can make decisions that lead to meaningful savings. Significant savings can also mean that a portion of your member responsibility amount can be waived for your sharing request.
What to Do After You Receive It
Once you receive your estimate, take time to review it carefully. If anything is unclear, ask your provider for clarification.
Submit your estimate to EverTrust as soon as you receive it from your provider. This allows the team to help assess whether pricing aligns with fair-cost expectations and to provide guidance on next steps.
Taking this extra step can help ensure a smoother experience and reduce the likelihood of unexpected costs.
The Bottom Line
The Good Faith Estimate is one of the most valuable tools available to patients today. It provides transparency, reduces uncertainty, and helps you take control of your healthcare costs.
By requesting and reviewing your estimate before receiving care, and understanding when you should receive it, you can make more informed decisions and help ensure a smoother experience with your EverTrust membership.