Patients often receive a quoted price for medical services, but bills can sometimes exceed initial estimates. Under the No Surprises Act, which took effect in 2022, patients have the right to dispute bills that are $400 or more above the good-faith estimate provided by healthcare providers. This rule primarily applies to uninsured individuals or those without insurance for specific treatments, while insured patients facing out-of-network charges have a different process for disputing their bills.
To initiate a dispute, patients need to present a final bill, the initial estimate, and contact information for the healthcare provider. Disputes must be filed within 120 days of receiving the final bill, and a $25 non-refundable fee is necessary for processing. If the dispute is resolved in the patient’s favor, this fee is deducted from the total owed.
During the dispute process, providers cannot engage in collection activities or impose late fees. However, patients are not guaranteed a favorable outcome; reviewers may uphold charges that are deemed necessary or reasonably unexpected.
For insured patients receiving unexpected out-of-network bills, it may be more effective to contact their insurers or file a complaint under the No Surprises Act. Other options include requesting an itemized bill, negotiating directly with the provider, or exploring available financial assistance.
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