If you’re uninsured or self-pay, the No Surprises Act entitles you to a written Good Faith Estimate (GFE) before scheduled care. If your final bill from a provider is at least $400 more than their GFE, you can challenge it through the federal Patient-Provider Dispute Resolution (PPDR) process — an independent reviewer decides what you owe.
The key numbers
- $400 threshold — PPDR applies when the billed charge from a single provider/facility is $400 or more above that provider’s GFE.
- 120 days — you must initiate the dispute within 120 days of receiving the bill.
- ~$25 — there’s a small administrative fee to file (waivable in hardship; confirm the current amount).
- Collections paused — while PPDR is pending, the provider must not move the bill to collections or threaten you over it.
Step 1 - the letter to the provider (try this first)
[Your full name]
[Your address]
[City, State ZIP]
[Phone] | [Email]
[Date]
[Provider / facility billing department]
[Billing address]
Re: Final bill exceeds Good Faith Estimate by $400+
Patient: [Name, date of birth] (uninsured / self-pay)
Account / Statement number: [number]
Date(s) of service: [dates]
Good Faith Estimate dated: [date] GFE total: $[amount]
Final billed amount: $[amount] Difference: $[amount]
To the billing department:
As an uninsured/self-pay patient, I received a Good Faith Estimate of $[amount]
for the care above. My final bill is $[amount] - $[amount] more than the
estimate, which is $400 or more above the GFE.
Please review and adjust this bill to the Good Faith Estimate amount, or explain
in writing the specific reason for the difference. If we cannot resolve this, I
intend to initiate the federal Patient-Provider Dispute Resolution (PPDR)
process. Please do not send this bill to collections while it is in dispute.
Sincerely,
[Your signature]
[Your printed name]
Step 2 - if they won’t fix it: file PPDR
If the provider won’t adjust the bill, start the PPDR process at cms.gov/nosurprises (search “patient-provider dispute resolution”). File within 120 days of getting the bill, attach the GFE and the bill, and pay the administrative fee. A Selected Dispute Resolution (SDR) entity will review it and set the amount you owe.
Notes. PPDR is only for uninsured or self-pay patients with a GFE — if you have insurance, use the No Surprises Act or appeal letters instead. The $400 threshold, 120-day window, and ~$25 fee are set by federal rule and can change, so confirm the current figures at cms.gov/nosurprises. General information, not legal advice.