The GFE requirement applies when a patient has no coverage or chooses not to use it. The estimate must be provided on request or when a service is scheduled at least three business days out, and if the final bill exceeds the estimate by $400 or more, the patient can dispute it.
For insured patients, the Act envisioned providers sending a GFE to the plan, which would produce an advanced explanation of benefits for the patient. That mechanism is not yet enforced, which is why practices that want to tell insured patients what they will owe need their own benefits verification and estimation process.
