Patient-Provider Dispute Eligibility
Whether a self-pay bill can go to patient-provider dispute resolution.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Provider 1: amount on the estimate
- 1000 USD
- Provider 1: total billed
- 1450 USD
- First bill received
- 2026-09-01
Result: Eligible for patient-provider dispute resolution for provider 1: billed at least $400 over the estimate. Start by December 30, 2026, 120 calendar days after receiving the first bill (149.620(c)(1)).
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Provider 1: amount on the estimate
- Provider 1: total billed
- Provider 2: amount on the estimate
- Provider 2: total billed
- Provider 3: amount on the estimate
- Provider 3: total billed
- First bill received (YYYY-MM-DD)
How this is calculated
Citation
45 CFR 149.620: a provider's or facility's total billed charges at least $400 more than its expected charges on the good faith estimate are eligible for patient-provider dispute resolution, started within 120 calendar days of receiving the first bill. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.