No Surprises Act dispute: how the patient-provider dispute process works
Who qualifies for a No Surprises Act patient-provider dispute, the $400 threshold, the 120-day deadline, and how to file.
Who it's for
Uninsured and self-pay patients who got a Good Faith Estimate (GFE) before a scheduled service and were then billed at least $400 more than the estimate by any one provider or facility.
Deadline and fee
You must start the dispute within 120 calendar days of receiving the initial bill. The administrative fee is $25, and it's refunded if the decision goes in your favor.
How to start
Start through the federal process at cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059. Have your GFE and bill ready. While the dispute is open, the provider can't send the bill to collections.
Surprise bills when you're insured
Insured patients are protected from most surprise out-of-network bills for emergency care and for certain care at in-network facilities. If you get one, contact your insurer and the help desk. The patient-provider dispute process is only for self-pay patients.
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What if I never got a Good Faith Estimate?
Providers must give one to uninsured or self-pay patients when you schedule care at least 3 business days ahead or ask for one. If you didn't get one, report it to the Help Desk.
Does the $400 apply to the total bill?
It applies per provider or facility, comparing each one's bill with its own estimate.
Is this legal advice?
No. This is a summary of the federal rules as of October 2026. Check cms.gov/nosurprises for current details.
Educational information, not legal advice. Laws and deadlines change, so verify with official sources. More guides: How to dispute a medical bill · How to request an itemized medical bill (free letter template) · Medical billing error checklist · Hospital charity care · ER bill too high? What to check and how to fight it · BillRebuttal vs. hiring a medical bill advocate · BillRebuttal vs. Dollar For