Guides / Medical bills
Getting a price before you are treated
If you are paying cash, you have a legal right to a written price before scheduled care. Most people never ask for it.
This one is genuinely useful and almost entirely unknown, and it applies to anyone paying their own way.
What you are entitled to
Under the No Surprises Act, a provider must give uninsured and self-pay patients a written Good Faith Estimate of what scheduled care will cost. It applies when the care is scheduled at least three business days ahead, and it has to include the related services expected as part of the same episode of care, not just the headline item.
That means the estimate for a procedure should account for the facility, the surgeon and the anaesthetist, rather than arriving as three separate surprises.
The $400 rule
If the final bill comes in $400 or more above the Good Faith Estimate, you can challenge it through the federal patient-provider dispute resolution process.
Knowing that number changes the conversation. A written estimate is not a courtesy quote, it is the figure the bill will be measured against.
Why this matters more than it used to
Since 2026, hospitals also have to publish actual negotiated dollar amounts in machine-readable files, rather than estimates or formulas like "120% of Medicare". The rule now requires median and 10th and 90th percentile amounts derived from real claims data.
Combined with a Good Faith Estimate, that is the first time an ordinary person has had two independent ways to check a price before agreeing to it.
The same MRI, 7 Montana hospitals
What a self-payer is asked for an MRI of the brain without contrast, billing code 70551. $2,646 at the most expensive against $672 at the cheapest, 3.9 times the price for the same scan.
See the numbers
| Hospital | Price |
|---|---|
| Big Horn County | $672 |
| Sidney | $1,013 |
| Clark Fork Valley | $1,859 |
| Livingston | $1,936 |
| Barrett, Dillon | $2,334 |
| Marcus Daly, Hamilton | $2,538 |
| Great Falls Clinic | $2,646 |
Each hospital's own machine-readable price file, extracted August 2026. See the full comparison.
How to ask
Say this, more or less: "I am self-pay. I would like a Good Faith Estimate in writing before we schedule, including any related services."
You do not need to explain yourself, argue, or cite the statute. Scheduling staff deal with this daily. If the person you are speaking to does not know what it is, ask for the billing department.
If you are a CoreMed member
You are a self-pay patient for anything outside your membership, so this applies to you directly. Presenting as self-pay is also how you get the self-pay rate, which is frequently far below the billed price.
Sources
- CMS, No Surprises Act: Key Consumer Protections
- CMS, Understand your rights against surprise medical bills
- CMS, Hospital Price Transparency
Checked 21 August 2026. Rules and thresholds change, so follow the source before relying on a figure here.
Who publishes this. CoreMed Healthcare is a Montana healthcare membership company. We publish these guides because we think the information should be easy to find, and because our own members need it. They are written to answer your question rather than to sell you a membership: where the right answer is a hospital charity care programme or a different kind of plan, that is what they say. Nothing here is legal, tax or medical advice.
Common questions
Does this apply if I have insurance?
The Good Faith Estimate requirement covers uninsured and self-pay patients. If you have insurance but choose not to use it for a service, you are self-pay for that service.
How far ahead do I have to schedule?
The requirement applies to care scheduled at least three business days in advance. You can request an estimate for anything, but that is the threshold at which they must provide one.
What if the bill is higher than the estimate?
If it is $400 or more above, you can use the patient-provider dispute resolution process. Below that, it is worth calling and asking for the difference to be explained.
Is an estimate binding?
It is not a fixed quote, but it is the benchmark the dispute process measures against, which gives it real weight.
Related
Hospital charity care in Montana
Most Montana hospitals are legally required to have a programme that can reduce your bill to nothing. Hardly anyone knows to ask.
Surprise bills and balance billing
Some bills you are simply not allowed to be sent. Knowing which ones is worth real money.
Read the itemised bill first
The one-line summary is not a bill. Ask for the itemised version, then check these six things.