Good Faith Estimate
The hospital gave me an estimate and the bill is much higher. Can I dispute it?
If you are uninsured, or insured but paying yourself, a provider is required to give you a Good Faith Estimate in writing before a scheduled service.
If the final bill comes in $400 or more above that estimate, you can dispute it through a federal process — and the existence of that process is usually enough on its own.
What you should have received
For scheduled care, a written estimate covering the expected charges, given before the service. You are entitled to one on request for any service, and automatically for anything scheduled at least three days out.
It should cover the whole episode, including the clinicians the facility knows will be involved — not just the facility's own charges.
The threshold
$400. If the billed amount exceeds the estimate by at least that, you may use the patient-provider dispute resolution process. Below it, you can still ask, but the formal route is not available.
There is a deadline: generally 120 days from receiving the bill. Do not let it pass while you wait for a call back.
Try the billing office first
Most of these resolve without the formal process, because the provider would rather correct the bill than pay the fee for a third-party review.
Please explain the [amount] difference from the Good Faith Estimate. I am considering the federal patient-provider dispute resolution process if it cannot be reconciled.
That sentence is usually enough. Say it calmly — it reads as informed rather than threatening, which is the tone that gets things done.
When a higher bill is legitimate
An estimate is an estimate. Things genuinely change:
- Complications during the procedure
- A finding that required more work than planned
- A service you asked for on the day
What is not a good reason is a charge for something the provider knew about in advance and left off. If the estimate omitted the anaesthesiologist entirely, that is a defect in the estimate, not a surprise in the care.
If you use the formal process
You submit the estimate and the bill. A third-party reviewer decides which amount stands. There is a small administrative fee, which is waived at low incomes.
While a dispute is open, the provider is generally not permitted to send the bill to collections or charge late fees on the disputed amount. Say so in writing when you file.
Also worth doing
Ask about financial assistance at the same time, particularly at a nonprofit hospital. The two are not alternatives — a bill can be both wrong and reducible, and the financial assistance route often moves faster.
This is general information, not legal, medical or financial advice, and not a statement about your particular bill. A difference between two documents often has an ordinary explanation, and the billing office is the one who can give it.