Paying for online care yourself? Ask for a good faith estimate

Who counts as "self-pay"

The rule covers two groups. Under 45 CFR 149.610, an uninsured (or self-pay) individual is someone without coverage for the item or service, or someone who has coverage "but who does not seek to have a claim for such item or service submitted to such plan or coverage."

So you can have insurance and still count as self-pay for a visit, if you choose not to bill your plan for it.

What the estimate should list

CMS says a good faith estimate "should include expected charges for the scheduled health care items and services, including facilities fees, hospital fees, and room and board provided by the provider or facility."

It also has limits. Each estimate covers one provider or facility: "Good faith estimates only list expected charges for a single provider or facility." CMS says an estimate might not include:

• "Items or services related to your care that are scheduled separately"
• "Items or services related to your care that will be provided by another provider or facility."
• "Additional items or services that your doctor didn't anticipate before providing care."

That second point matters for online care. The visit, the lab and the pharmacy can be separate businesses that each bill on their own, so an estimate from one of them won't show the others' charges.

When it's due

Per CMS:

You can also ask for it in the format you prefer. CMS says it should be given to you "either printed on paper or emailed."

If the bill comes in much higher

Keep the estimate. CMS: "You'll need a good faith estimate if you need to dispute your bill. You can't dispute your bill without an estimate."

The federal dispute process applies when a bill is "substantially in excess" of the estimate. 45 CFR 149.620 defines that as "an amount that is at least $400 more than the total amount of expected charges listed on the good faith estimate for the provider or facility."

The clock is short. You start the process by submitting a notice to HHS "postmarked within 120 calendar days of receiving the initial bill," and the rule also calls for an administrative fee.

Questions to ask before you pay

This is a practical checklist, not regulatory text:

• Will you give me a good faith estimate for this visit?
• Which charges does it cover, and which charges come from someone else (labs, pharmacy, shipping)?
• Is this a one-time charge or does it repeat?
• What are the cancellation and refund terms?

For the difference between cash pay, copays and deductibles, read Cash pay vs copay vs deductible for telehealth.

This page is run by MediWells.

Common questions