Good Faith Estimate notice: what your website needs

The short answer

Uninsured and self-pay patients can get a Good Faith Estimate. Under the No Surprises Act rules (federal regulation), you must tell them so. Make the notice easy to find on your website. Post it where scheduling happens. Say it aloud when patients book or ask about cost. The written estimate follows on set deadlines (federal decision tree).

This is general information, not legal advice.

Key takeaways

Uninsured patients have a right to a Good Faith Estimate. So do patients whose coverage doesn’t cover the care. So do insured patients who choose not to use their coverage. People enrolled in a federal health care program don’t. Examples are Medicare, Medicaid and TRICARE (Centers for Medicare & Medicaid Services (CMS) decision tree).
The notice must be easy to find on the website and easy to see in the office. It must also be said aloud at booking or when cost comes up. The rule is 45 CFR 149.610, Title 45 of the Code of Federal Regulations (CFR).
Give the notice a page of its own. Then link to it from the footer, the fees page and the booking form.
The deadline for the written estimate depends on how far ahead the visit is booked (CMS decision tree).
There are two separate notices: the Good Faith Estimate notice and the surprise billing disclosure (CMS provider FAQ (frequently asked questions)).

What is a Good Faith Estimate, and who has a right to one?

A Good Faith Estimate is a written estimate of what care is expected to cost. It is for patients who aren’t billing insurance. The CMS decision tree names two groups. The first is uninsured patients. That includes patients who lack coverage for a particular item or service. The second is patients who have coverage but choose not to use it. They are called self-pay patients. Both groups have a right to an estimate in two cases. One is when they schedule care at least 3 business days ahead. The other is when they ask for an estimate or ask about cost. People enrolled in a federal health care program are not eligible, even if they don’t plan to use that coverage. Examples include Medicare, Medicaid and TRICARE.

The rule looks at how a provider practices, not at the specialty. The CMS provider FAQ says it applies broadly. It covers physicians and other providers acting within their scope of practice under state law. Scope of practice means the kinds of care state law allows a provider to give. Your specialty alone doesn’t settle the question.

The estimate itself has real detail. The CMS decision tree lists what it includes, among other things. It lists the expected items and services. It gives diagnosis codes and service codes. It shows the expected charges. And it explains the right to dispute the bill. Some services repeat, such as counseling or physical therapy. For these recurring services, a practice may give one estimate instead of one per visit. That estimate can cover no more than 12 months (45 CFR 149.610).

What do the rules say about the notice on your website?

Your website must make the right to an estimate easy to see. The right must also be easy to find in search. The rule is 45 CFR 149.610. That means Title 45 of the Code of Federal Regulations, section 149.610. It says details about getting a Good Faith Estimate must be written clearly. They must be prominently displayed on the practice website. That means placed where people will see them. They must be easily searchable from a public search engine. They must also be shown in the office. And they must be shown on-site where scheduling or questions about cost occur.

The same rule asks for two more things. These details must be said out loud when scheduling or when questions about cost come up. And they must be available in accessible formats. They must also be in the languages spoken by the people thinking about or scheduling care (45 CFR 149.610).

CMS has a sample Good Faith Estimate notice. It says the notice must be clearly visible in the office and on-site. It must also be easy to find on the provider’s website. The sample tells patients when to expect the written estimate. It says they can dispute a bill that is at least $400 more than the estimate for that provider or facility. It also says how to reach CMS by web, email and phone. The same CMS document links to sample Good Faith Estimate forms. Practices don’t have to use either exact form. But the form they use must include the required information.

Where should the notice go on your website?

Give the notice a page of its own that search engines can find. Then link to it from every place a self-pay patient is likely to look. The list below matches the wording of the rule to places on a practice website. These are practical placement ideas, not extra legal requirements.

A notice page of its own. Give it its own web address and a plain title, such as “Your right to a Good Faith Estimate”. This is the version a search engine can find.
A link in the footer on every page. The footer is the strip at the bottom of each page. The notice is then one click away from anywhere on the site.
A short line and link right under the booking form, or next to the booking button. That is where booking happens.
Links from the fees, insurance and booking pages. That is where cost questions start. See how to write an insurance plans accepted page.
The notice as real page text, not only an image or a scanned file. Then it can be found, read aloud by a screen reader and made larger.
A version in each language your front desk schedules in.

If I were setting up a small practice’s website today, here is where I’d put the notice: right under the form where the appointment details are filled in. That puts it next to online booking. The rule also asks for it to be easily searchable from a public search engine (45 CFR 149.610). So pair that line with the notice page, and link one to the other.

Is your site short on room for pages like these? A new website is a custom design for the practice with up to 8 pages. A website redesign refreshes up to 8 pages of existing content.

What must happen when a patient books or asks about cost?

When a patient books, the practice does three things. First, it asks about coverage. If the patient is uninsured or self-pay, two more steps follow. Second, it says the notice details out loud (45 CFR 149.610). Third, it starts the clock on the written estimate. That is for visits booked 3 or more business days ahead (CMS decision tree). The CMS provider FAQ says more about the coverage question. When scheduling, the practice must ask if the patient has coverage. If they do, it must ask if they want a claim sent to that coverage. A claim is the bill a practice sends to the plan.

In the scheduling workflows I saw, that question went like this. Do you have insurance? If yes, the scheduler asked for the insurance details to bill for the visit. The patient gave those details. If not, the patient said so clearly. The account was then marked as self-pay.

Self-pay patients asked about price at the front desk. In my experience, the front desk or the appointment scheduler should answer those questions. That matches the rule: the details must be said out loud when scheduling or when questions about cost come up (45 CFR 149.610). The website notice and the front desk answer should say the same thing.

The deadline for the written estimate depends on how far ahead the visit is booked. This table follows the CMS decision tree.

What happens	Written estimate is due (per the CMS decision tree)
The patient asks for an estimate	No later than 3 business days after the request.
Visit booked 3 to 9 business days ahead	No later than 1 business day after booking.
Visit booked 10 or more business days ahead	No later than 3 business days after booking.
Visit booked fewer than 3 business days ahead	Not required, unless the patient asks for an estimate or asks about cost. Then it is due within 3 business days of the request (45 CFR 149.610).

An estimate may be given by phone or in person if the patient asks. But a written one must follow, in the patient’s preferred form (CMS decision tree). The written estimate can be on paper or electronic. For example, it can come through a patient portal or email. It comes in the format the patient prefers (CMS sample notice).

An estimate is part of the patient’s medical record. If the patient asks, you must give them a copy of any estimate from the last 6 years (45 CFR 149.610).

In the workflows I saw, having no online payment link slowed down payment collection. Patients paid by check or in person, and that took longer. If an online payment option is available, payment can happen at the same time.

How does the notice fit with a self-pay or fees page?

The fees page and the notice belong side by side. The fees page says what services usually cost. The notice tells self-pay patients they can get an estimate for their own care. Link each one to the other.

A posted fee isn’t the estimate itself. The written estimate covers the expected items and services for that patient. It includes diagnosis and service codes and expected charges (CMS decision tree). Some patients qualify for a sliding fee discount. They may get an estimate that shows the undiscounted price, meaning the full price. Does your fees page mention a sliding scale? Then it can explain that the estimate may show the full price.

Getting the expectation right up front matters. In my 13+ years working in the US healthcare revenue cycle, the billing, payments, and scheduling side of medical practices, I saw a pattern. It showed up when a self-pay patient’s bill didn’t match what they expected. The pattern was an angry patient, unhappiness with the clinic and a bad review. Bills also stayed unpaid for a long time. It took a lot of back-and-forth work to correct the bill and collect the payment.

The rules give patients a path of their own, too. Say a bill is $400 or more above the estimate for a provider. Then the patient may be able to dispute it. The CMS decision tree says they would use the Patient-Provider Dispute Resolution process.

What about walk-ins and same-day visits?

A visit booked fewer than 3 business days ahead doesn’t need an estimate (CMS decision tree). The exception is when the patient asks for one or asks about cost. Any question about cost counts as a request. The estimate is then due within 3 business days of the request (45 CFR 149.610).

The CMS patient guide to Good Faith Estimates tells patients the same thing. If they aren’t using insurance, their provider usually must give an estimate. That is if they ask, or if they schedule at least 3 business days ahead.

Walk-ins still see the office side of the notice. The details must be shown in the office and on-site where scheduling or cost questions occur. They must also be said out loud when scheduling or when cost comes up (45 CFR 149.610). For same-day patients, the sign at the desk and the scheduler’s answer do more work than the website.

Is this the same notice as the surprise billing disclosure?

No. They are separate notices for different situations. The CMS provider FAQ treats the balance billing disclosure notice as a separate rule. Balance billing is when an out-of-network provider bills an insured patient more than their in-network share of the cost. The FAQ lists a few exceptions to the disclosure rule. One is for a provider who gives no items or services at a health care facility where balance billing protections apply. To use it, the provider must also give none in connection with a visit to such a facility.

	Good Faith Estimate notice	Balance billing (surprise billing) disclosure
What it covers	The right to an estimate of expected charges.	Protections against balance billing.
Who it is for	Uninsured and self-pay patients (CMS decision tree).	Patients enrolled in a group health plan or in group or individual health insurance coverage. It applies when they get care at, or in connection with a visit to, a facility where those protections apply (CMS provider FAQ).
Which providers	Physicians and other providers acting within their scope of practice under state law (CMS provider FAQ).	Providers giving items or services at, or in connection with a visit to, certain facilities. These are hospitals, hospital outpatient departments, critical access hospitals and ambulatory surgical centers. For emergency care, they also include independent freestanding emergency departments (CMS provider FAQ).

Does your practice see patients only in its own office? And never at, or in connection with a visit to, one of those facilities? Then check the facility list in the FAQ before you add the second notice to your site.

Mistakes to check for on your own site

Open your site on a phone and look for each one.

The notice is only an image or a scanned file, with no page text.
The notice sits several clicks deep, with no footer link.
There is no line about the estimate near the booking form or online booking link.
The fees page lists self-pay prices but has no link to the notice.
The website and the front desk say different things.
The notice is in one language, but the front desk schedules in others.
The Good Faith Estimate notice and the surprise billing disclosure are mixed into one confusing block.

Sources and next step

This guide uses original sources from CMS and the federal regulations:

CMS also has provider training and resources. They cover the Good Faith Estimate rules. They also cover the patient-provider dispute resolution rules.