Title 42, The Public Health and WelfareRelease 119-110

§300gg–137 Patient-provider Dispute Resolution

Title 42 › CHAPTER 6A — PUBLIC HEALTH SERVICE › SUBCHAPTER XXV — REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE › Part E — Health Care Provider Requirements › § 300gg–137

Last updated Sep 23, 2026|Official source

Summary

By January 1, 2022, the Secretary must create a way for an uninsured person who got a good-faith price estimate from a health provider under section 300gg–136, but was later billed a much higher amount, to ask a selected dispute resolver to decide what the person must pay instead of the billed charge. Uninsured individual: someone who lacks coverage for that item or service under a group health plan, group or individual insurance, a Federal health care program (see section 1320a–7b(f)), or a federal employee plan under chapter 89 of title 5—or who has coverage but chooses not to file a claim. The Secretary must provide a method to select an independent, certified resolver that has no role in the dispute, no close family, financial, or professional ties, and no other conflicts. The Secretary must tell both the person and the provider who was chosen, set a participation fee that does not block access, and run or approve the certification process meeting at least the criteria in section 300gg–111(c).

Full Legal Text

Title 42, §300gg–137

The Public Health and Welfare, Source: USLM XML via OLRC

(a)In general

Not later than January 1, 2022, the Secretary shall establish a process (in this subsection referred to as the “patient-provider dispute resolution process”) under which an uninsured individual, with respect to an item or service, who received, pursuant to section 300gg–136 of this title, from a health care provider or health care facility a good-faith estimate of the expected charges for furnishing such item or service to such individual and who after being furnished such item or service by such provider or facility is billed by such provider or facility for such item or service for charges that are substantially in excess of such estimate, may seek a determination from a selected dispute resolution entity for the charges to be paid by such individual (in lieu of such amount so billed) to such provider or facility for such item or service. For purposes of this subsection, the term “uninsured individual” means, with respect to an item or service, an individual who does not have benefits for such item or service under a group health plan, group or individual health insurance coverage offered by a health insurance issuer, Federal health care program (as defined in section 1320a–7b(f) of this title), or a health benefits plan under chapter 89 of title 5 (or an individual who has benefits for such item or service under a group health plan or individual or group health insurance coverage offered by a health insurance issuer, but who does not seek to have a claim for such item or service submitted to such plan or coverage).

(b)Selection of entities

Under the patient-provider dispute resolution process, the Secretary shall, with respect to a determination sought by an individual under subsection (a), with respect to charges to be paid by such individual to a health care provider or health care facility described in such paragraph for an item or service furnished to such individual by such provider or facility, provide for— (1)

(2)the provision of a notification of such selection to the individual and the provider or facility (as applicable) party to such determination.

An entity selected pursuant to the previous sentence to make a determination described in such sentence shall be referred to in this subsection as the “selected dispute resolution entity” with respect to such determination.

(c)Administrative fee

The Secretary shall establish a fee to participate in the patient-provider dispute resolution process in such a manner as to not create a barrier to an uninsured individual’s access to such process.

(d)Certification

The Secretary shall establish or recognize a process to certify entities under this subparagraph. Such process shall ensure that an entity so certified satisfies at least the criteria specified in section 300gg–111(c) of this title.

Reference

Citations & Metadata

Citation

42 U.S.C. § 300gg–137

Title 42, The Public Health and Welfare

Last Updated

Sep 23, 2026

Release point: 119-110