Dispute a medical bill | CMS (2024)

When your provider charged $400 or more than your good faith estimate

Did your provider charge at least $400 more than your good faith estimate? You may be eligible to dispute your bill. This page explains this “patient-provider dispute resolution” process (PPDR).

When you dispute a bill, an independent third party will review your bill and determine an appropriate payment.

On this page

• How you qualify
• What to expect
• What you need
• Frequently asked questions
• Start a dispute

How you qualify

You can only dispute a bill if:

• When you got care, you didn't have or didn’t use your health insurance to pay for it.
• Before you got care, you told your provider that you weren’t using insurance to pay for it.
• You got care on or after January 1, 2022.
• You have a good faith estimate that you received from your health care provider or facility three (3) days before your scheduled appointment.
• You have aninitial bill dated within the last 120 calendar days (about 4 months).
• One of your providers or facilities charged at least $400 more than their good faith estimate.

What to expect

No matter the outcome, your costs won’t increase if you dispute your bill.

When you got care, you might have needed items or services that your doctor couldn’t reasonably have anticipated. In that case, the reviewer will find that the cost of your care was appropriate, and leave your bill as-is.

But they might find that your provider or facility should have been able to tell you about those costs in advance, or that those unplanned services and supplies weren’t medically necessary. In those cases, your provider must reduce your bill.

What you need

You’ll need a digital or paper copy of:

• Your good faith estimate
  • You'll also need your provider's contact information.
• Your bill
• $25 non-refundable administrative fee
  • The dispute process doesn’t start until the $25 fee is paid.
  • If the dispute is decided in your favor, the $25 will be deducted from the amount you owe your provider.

Don't mail any original documents.

Note:We reset this form after 15 minutes of inactivity to protect your data. Your answers will be deleted if the form closes.

Frequently asked questions

What if I get a bill or get sent to collections during the dispute process?

While you’re in the process of disputing a bill, your provider or facility can’t:

• Move your bill into collections, or threaten to do so
• Collect any existing late fees on unpaid bills until the dispute process ends
• Take action against you because you're disputing your bill

If your bill is already in collections, your provider or facility must stop pursuing payment until the dispute process is resolved.

You can take action if a debt collector contacts you about an unexpected out-of-network medical bill, or if you see a surprise medical charge listed as a negative item on your credit report. Reach out to the Consumer Financial Protection Bureau online or by calling 1-855-411-2372.

How do I pay the dispute administrative fee?

You’ll need to pay a $25 non-refundable administrative fee to file a dispute.

If the dispute is decided in your favor, the $25 will be deducted from the amount you owe your provider.

You can pay this fee online via credit card, PayPal, or Venmo.

You can pay by mail via money order or cashier’s check if you submit your dispute form through the mail. Cash and personal checks aren’t accepted.

What if I come to an agreement about my bill with my provider or facility before the dispute process ends?

You and your health care provider or facility can settle the payment amount before the dispute process ends.

They may offer to reduce your bill, or you may agree to pay the billed amount in full.

If you and your provider or facility agree on a payment amount, the provider must:

• Reduce your bill by at least $12.50 (half of the $25 administrative fee), and
• Notify the independent third-party reviewer that you've reached a settlement.

What do I do if I don’t qualify for the dispute process?

If you didn’t use health insurance, review our financial assistance guide for ways to reduce your bill. You can also submit a complaint if your provider didn’t give you a good faith estimate.

If you used health insurance,you don't qualify to dispute a bill. You should submit a complaintif you received care on or after January 1, 2022, and:

• You received an out-of-network bill for a visit to the emergency room or an in-network facility,
• You already paid more than in-network rates for a visit to the emergency room or an in-network facility, or
• Your provider didn’t follow the rules around notice and consent

Your insurer may have decided not to pay part or all of a claim. If you think this decision violates the No Surprises Act, appeal your bill. Follow the process described in your plan's documents and denial notices.

Learn more about your rights when using health insuranceunder the No Surprises Act.

Note: If you got a bill and haven't met your deductible, that's not a violation of the No Surprises Act.

A dispute was decided in my favor, but the provider is still billing me or sent my bill to collections. What should I do?

Submit a complaintto the No Surprises Help Desk. We'll review the situation and let you know about your next steps.