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PHSA §2799B-1PHSA §2799B-745 CFR §149.620

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Good-faith estimate dispute (PPDR) for self-pay patients

The Patient-Provider Dispute Resolution pathway exists for uninsured and self-pay patients. If your actual bill exceeds your good-faith estimate by $400 or more, you can dispute through CMS — no insurance company involved.
Last verified May 2026
Statute-pinned · primary sources only

Who PPDR is for

PPDR is for patients who are uninsured or self-pay for a scheduled item or service. It is NOT for insured patients (who have a separate NSA complaint pathway). The provider must have given you a written good-faith estimate (GFE) at the time of scheduling.

The eligibility threshold

Under 45 CFR §149.620, you can initiate PPDR if your actual billed charges exceed the GFE by $400 or more. The threshold applies to the total bill, not per-line-item.

How to file

  1. Within 120 calendar days of receiving the bill, file through the CMS PPDR portal (linked from cms.gov/nosurprises/consumers).
  2. Pay the $25 administrative fee at filing. If your dispute is decided in your favor, the fee may be recovered.
  3. Submit supporting documents: the original GFE, the actual bill, and any provider correspondence.
  4. A Selected Dispute Resolution (SDR) entity reviews the dispute and issues a determination.

What's at stake

The SDR entity can set the amount you owe at the GFE amount or somewhere between the GFE and the billed amount, based on the provider's documentation. The provider cannot pursue collection on the disputed amount while the PPDR is active.

If you didn't get a GFE

Providers and facilities are required to give self-pay/uninsured patients a written GFE upon scheduling or upon patient request (PHSA §2799B-6). If you didn't get one and the bill is unexpectedly high, this is a separate provider-disclosure violation. Report through the CMS Help Desk at 1-800-985-3059.

Quick answers

Frequently asked

Who can file a Patient-Provider Dispute Resolution (PPDR)?
Uninsured or self-pay individuals only. Insured patients use a different pathway (NSA complaint via the CMS Help Desk).
What is the $400 threshold?
Under 45 CFR §149.620, you can initiate PPDR if your actual billed charges exceed your written good-faith estimate (GFE) by at least $400. The threshold applies to the total bill, not per-line-item.
How long do I have to file PPDR?
120 calendar days from receipt of the bill. There is a $25 administrative fee payable when you file. If your dispute is decided in your favor, the fee may be recovered.
What if I didn't get a good-faith estimate?
Providers are required by PHSA §2799B-1 to give uninsured/self-pay patients a written GFE at scheduling or upon request. If you didn't receive one, that is a separate provider-disclosure violation — report it to the CMS No Surprises Help Desk at 1-800-985-3059.

Related healthcare resources

Informational, not medical, legal, or insurance advice. Consult a healthcare-billing attorney or patient-advocate before acting on a No Surprises Act dispute. The free CMS NSA complaint pathway is 1-800-985-3059.