Resolving billing disagreements between consumers and providers
Starting in January 2022, if you’re uninsured or self-pay (insured but not planning to use your insurance to pay for your care), health care providers and facilities must give you a good faith estimate before you get care.
If you get your bill and find you were charged an amount that’s $400 or more than what’s on your good faith estimate, you can use a new process to request that an independent third-party, called a dispute resolution entity, review your case and determine an appropriate payment. This process is called “patient-provider dispute resolution.”
The dispute resolution entity will review the good faith estimate, your bill, and information submitted by your provider or facility to determine if you should pay the amount on your good faith estimate, the billed charge, or an amount in between the two.
There’s a $25 non-refundable administrative fee to start this process.
Eligibility for dispute resolution
You’ll be eligible to use this process if:
- You’re uninsured or self-pay (you have insurance but didn’t use it to pay for your health care item or service).
- You scheduled and received the medical items or services on or after January 1, 2022.
- You have a good faith estimate from your provider.
- You have a bill dated within the last 120 calendar days (about 4 months).
- The difference between the good faith estimate and the bill from any single provider or facility is at least $400.
Note: The good faith estimate may have expected costs from more than one provider. You’re eligible for the patient-provider dispute resolution process only if your bill from an individual provider or facility is at least $400 more than the total expected costs on the good faith estimate from that provider or facility.
How to start the billing dispute process
If you meet all of the conditions above, you’re eligible for the dispute resolution process. You’ll need a copy of your good faith estimate and a copy of your bill to begin the process. We’ll ask you to provide copies of these documents and to pay an administrative fee.
A $25 non-refundable administrative fee is required to start the patient-provider dispute resolution process. If the dispute resolution entity decides in your favor, this amount will be deducted from the amount you owe your provider. You can pay this fee online, or you can mail a money order or cashier’s check when you submit your dispute form through the mail. Personal checks aren’t accepted. If you mail your dispute form but pay online, you’ll get an email with information on how to complete your payment online once we get your dispute form.
Your protections during the patient-provider dispute resolution process
While the dispute resolution process is pending, your provider or facility can’t threaten to take any action against you.
- Thery can’t move your bill for the disputed item or service into collections or threaten to do so. If the bill is already in collections, the provider or facility has to pause this action.
- Your provider or facility can’t collect any late fees on unpaid bills until the dispute process has ended.
If you’re having an issue with debt collection, you can submit a complaint with the Consumer Finance Protection Bureau by calling (855) 411-CFPB (2372).
Coming to an agreement before the dispute process ends
At any point after the dispute resolution process starts, but before a determination is made, you and your provider or facility can settle the payment amount through financial assistance, offering to let you pay an amount lower than the billed amount, or you agreeing to pay the billed charges in full.
If you and your provider or facility agree on a payment amount, they’ll be required to reduce your bill by at least half of the $25 administrative fee. Your provider also must notify the dispute resolution entity that a settlement has been reached.
For help with surprise bills
- Call the No Surprises Help Desk at 1-800-985-3059.
- You can get help in a language other than English by contacting the No Surprises Help Desk.
- Call the No Surprises Help Desk to get information in an accessible format, like large print, Braille, or audio, at no cost to you.