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Good Faith Estimates: What You Owe Self-Pay Patients

The No Surprises Act requires a written estimate for uninsured and self-pay patients — an obligation most small practices are quietly not meeting.

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2 min read · by White Glove Medical Billing
A blank price tag tied to nothing

Most of the coverage around the No Surprises Act focused on balance billing and out-of-network emergencies. A quieter provision applies to every practice: uninsured and self-pay patients are entitled to a written estimate before scheduled care.

Who it covers

Patients with no insurance, and patients who have insurance but choose not to use it for the service. The second group is easy to miss — someone paying cash for a visit their plan would cover is a self-pay patient for this purpose.

What it has to contain

  • The expected charges for the primary service and items reasonably expected with it.
  • Service and diagnosis codes.
  • Provider details.
  • Delivery in writing, within a timeframe tied to when the service was scheduled or requested.

The "reasonably expected with it" part is what practices underestimate. An estimate covering only the office visit, when labs and a procedure are anticipated, is not a complete estimate.

Why practices are not doing it

Mostly because nobody told them. The rule arrived alongside hospital-focused requirements and the practice-level obligation got lost. It also requires the front desk to identify self-pay status at scheduling rather than at check-in, which is a workflow change rather than a form.

The operational version

Flag self-pay at scheduling. Keep an estimate template per common service. Deliver in writing, keep a copy, and note the date. It is not a large amount of work once the trigger exists — the difficulty is entirely in noticing that it applies.

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