---
kind: "section"
citation: "42 U.S.C. § 300gg–137"
title: "42"
title_heading: "The Public Health and Welfare"
number: "300gg–137"
heading: "Patient-provider dispute resolution"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/300gg-137"
units:
  - "Chapter 6A — Public Health Service"
  - "Subchapter XXV — Requirements Relating to Health Insurance Coverage"
  - "Part E — Health Care Provider Requirements"
---

# §300gg–137. Patient-provider dispute resolution

- (a) **In general—** Not later than January 1, 2022, the [Secretary](/usc/42/201.md?p=c) shall establish a process (in this subsection referred to as the “patient-[provider](/usc/42/299b–21.md?p=8) dispute resolution process”) under which an uninsured individual, with respect to an item or [service](/usc/42/201.md?p=a), who received, pursuant to [section 300gg–136 of this title](/usc/42/300gg–136.md), from a [health care provider](/usc/42/300aa–33.md?p=1) or health care facility a good-faith estimate of the expected charges for furnishing such item or [service](/usc/42/201.md?p=a) to such individual and who after being furnished such item or [service](/usc/42/201.md?p=a) by such [provider](/usc/42/299b–21.md?p=8) or facility is billed by such [provider](/usc/42/299b–21.md?p=8) or facility for such item or [service](/usc/42/201.md?p=a) 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](/usc/42/299b–21.md?p=8) or facility for such item or [service](/usc/42/201.md?p=a). For purposes of this subsection, the term “uninsured individual” means, with respect to an item or [service](/usc/42/201.md?p=a), an individual who does not have benefits for such item or [service](/usc/42/201.md?p=a) under a [group health plan](/usc/42/300bb–8.md?p=1), group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2), Federal health care [program](/usc/42/274l–1.md?p=4) (as defined in [section 1320a–7b(f) of this title](/usc/42/1320a–7b.md?p=f)), or a health benefits plan under [chapter 89](/usc/5/chptIII-sptG-ch89.md) of title 5 (or an individual who has benefits for such item or [service](/usc/42/201.md?p=a) under a [group health plan](/usc/42/300bb–8.md?p=1) or individual or [group health insurance coverage](/usc/42/300gg–91.md?p=b-4) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2), but who does not seek to have a claim for such item or [service](/usc/42/201.md?p=a) submitted to such plan or coverage).
- (b) **Selection of entities—** Under the patient-[provider](/usc/42/299b–21.md?p=8) dispute resolution process, the [Secretary](/usc/42/201.md?p=c) shall, with respect to a determination sought by an individual under [subsection (a)](#a), with respect to charges to be paid by such individual to a [health care provider](/usc/42/300aa–33.md?p=1) or health care facility described in such paragraph for an item or [service](/usc/42/201.md?p=a) furnished to such individual by such [provider](/usc/42/299b–21.md?p=8) or facility, provide for—
  - (1) a method to select to make such determination an entity certified under [subsection (d)](#d) that—
    - (A) is not a party to such determination or an [employee](/usc/42/300gg–91.md?p=d-5) or agent of such party;
    - (B) does not have a material familial, financial, or professional relationship with such a party; and
    - (C) does not otherwise have a conflict of interest with such a party (as determined by the [Secretary](/usc/42/201.md?p=c)); and
  - (2) the provision of a notification of such selection to the individual and the [provider](/usc/42/299b–21.md?p=8) 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](/usc/42/201.md?p=c) shall establish a fee to participate in the patient-[provider](/usc/42/299b–21.md?p=8) 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](/usc/42/201.md?p=c) shall establish or recognize a process to certify entities under this subparagraph.[^1] Such process shall ensure that an entity so certified satisfies at least the criteria specified in [section 300gg–111(c) of this title](/usc/42/300gg–111.md?p=c).

## Footnotes

[^1]: So in original.

## Source credit

(July 1, 1944, ch. 373, title XXVII, § 2799B–7, as added Pub. L. 116–260, div. BB, title I, § 112, Dec. 27, 2020, 134 Stat. 2867.)