Good Faith Estimate for an MRI: Your Right to a Price in Writing

If you are uninsured or choose to pay for an MRI yourself instead of using insurance, federal law entitles you to a written Good Faith Estimate of the expected charges before you are scanned. The estimate comes from the No Surprises Act, which took effect for 2022 care. If the final bill from a provider is at least $400 more than the estimate for that provider, you can start a federal payment dispute resolution process. Knowing your rights gives you leverage when you shop for a scan, and a document to compare with the bill.

Who is entitled to a Good Faith Estimate

You are covered if you are:

• Uninsured, or
• Insured but choosing not to submit the claim to your health plan, in other words paying out of pocket instead.

The rule applies to health care providers and facilities, including imaging centers and hospitals. It does not replace the Explanation of Benefits your insurer sends when claims are filed; insured patients using their coverage get that process instead, with its own estimate rules for some plans.

When the estimate is due

The deadlines depend on how far ahead the scan is scheduled. In outline:

The key habit is simple: ask for the estimate every time, and ask in writing, by email or portal message. Confirm the current timelines on the CMS website, since agency guidance can be updated.

What the estimate should contain

A compliant Good Faith Estimate generally includes:

• Your name and the date.
• A description of the primary service (for example, "MRI lumbar spine without contrast") and its billing code.
• The expected charges for the items and services, including the facility and professional fees when they come from the same provider.
• The provider's name, tax ID and contact information.
• A statement of your right to dispute a bill that exceeds the estimate.

Providers must include other providers they expect to be involved in the same episode of care. For MRI this can include a separate radiologist group. If the radiologist bills independently, the imaging center may be required to coordinate the estimate, or you may need to request one from the radiologist too. Ask directly: "Will a different company bill me for reading the scan, and have you included their charge?"

The $400 dispute rule

If the billed charges from a provider or facility are at least $400 more than the estimate from that same provider, you can use the patient-provider dispute resolution process run through the Centers for Medicare & Medicaid Services. You must start the process within 120 calendar days of the date of the bill. A neutral reviewer called a selected dispute resolution entity decides what you owe. There is a small administrative fee, and the outcome depends on the evidence you submit. Keep:

1. The Good Faith Estimate.
2. The itemized bill.
3. Any emails or call notes about the price.

The process exists for self-pay patients and is not a way to appeal an insurance denial. For disagreements with your insurer, use the appeal process described in your plan documents.

Worked example (illustrative)

You schedule a brain MRI without contrast three weeks ahead and pay cash.

• Good Faith Estimate: $750 for the scan and facility; reading fee not listed.
• Final bill: $750 from the center plus a separate $380 from a radiologist group.

The center's charge matches its estimate, so there is no dispute against the center. The radiologist group billed $380 and was not included in any estimate, so ask whether the group should have provided one, and request it. A separate $380 bill does not automatically cross the $400 threshold, because the threshold compares each provider's charge to its own estimate; the lack of an estimate from the group is the real problem to raise. If the radiologist's bill had been $400 or more above an estimate, you could dispute.

Tips for using the estimate when shopping

1. Request estimates from three providers before choosing; each is a written price.
2. Ask for the CPT code on each estimate and compare them line by line.
3. Confirm the estimate covers the whole episode. Contrast, sedation or a second body area can be extras.
4. Save the document and take it to the scan.
5. Ask to update the estimate if your doctor changes the order.
6. Do not rely on a phone quote. A verbal price is not a Good Faith Estimate and is hard to prove later.

Related billing protections

• Hospital price transparency: federal rules require hospitals to post prices online, including cash prices.
• Surprise billing limits: restrictions apply to out-of-network emergency care and certain non-emergency ancillary services at in-network hospitals and surgical centers; freestanding imaging centers are not covered in the same way.
• Billing errors: you always have the right to an itemized bill. See what to do if an MRI bill is too high.

When to consult a professional

For a large bill, a patient advocate or attorney experienced in medical billing can help. Free help is available from your state insurance department and from nonprofit patient advocacy organizations. This guide describes the rule in general terms, and the CMS website has the current forms and rules.

Frequently asked questions

Do I get a Good Faith Estimate if I have insurance?

Not when you use your insurance, since that follows a different process. If you decide to pay without submitting a claim, you are treated as self-pay and are entitled to one.

Is a quote on the phone enough?

No. Ask for the written estimate. A verbal price is hard to enforce.

What if I never got an estimate?

Ask for one now and document the request. The dispute process is also tied to the estimate, so lacking one weakens your position, but you can still complain to CMS and negotiate.

How long do I have to dispute?

You must start within 120 calendar days of the date on the bill that exceeds the estimate.

Sources

• Centers for Medicare & Medicaid Services — No Surprises Act, Good Faith Estimate and dispute resolution
• HealthCare.gov — consumer explanation of surprise billing protections
• Patient Advocate Foundation — free help with medical bills