{"identifier":"/us/usc/t42/s300gg\u2013137","title":42,"num":"\u00a7\u202f300gg\u2013137.","heading":"Patient-provider dispute resolution","text":"\u00a7\u202f300gg\u2013137.\nPatient-provider dispute resolution\n(a)\nIn general\nNot later than\nJanuary 1, 2022\nsection 300gg\u2013136 of this title\nsection 1320a\u20137b(f) of this title\n(b)\nSelection of entities\nUnder 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\u2014\n(1) a method to select to make such determination an entity certified under subsection (d) that\u2014\n(A) is not a party to such determination or an employee or agent of such party;\n(B) does not have a material familial, financial, or professional relationship with such a party; and\n(C) does not otherwise have a conflict of interest with such a party (as determined by the Secretary); and\n(2) the provision of a notification of such selection to the individual and the provider or facility (as applicable) party to such determination.\nAn entity selected pursuant to the previous sentence to make a determination described in such sentence shall be referred to in this subsection as the \u201cselected dispute resolution entity\u201d with respect to such determination.\n(c)\nAdministrative fee\nThe 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\u2019s access to such process.\n(d)\nCertification\nThe Secretary shall establish or recognize a process to certify entities under this subparagraph.\n1\n1 So in original.\nsection 300gg\u2013111(c) of this title","url":"https://projectusc.org/usc/t42/s300gg\u2013137.html","content":[{"t":"sec","id":"/us/usc/t42/s300gg\u2013137","children":[{"t":"num","text":"\u00a7\u202f300gg\u2013137."},{"t":"heading","text":"Patient-provider dispute resolution"},{"t":"subsec","id":"/us/usc/t42/s300gg\u2013137/a","children":[{"t":"num","text":"(a)"},{"t":"heading","text":"In general"},{"t":"content","children":[{"t":"p","text":"Not later than ","children":[{"t":"text","text":"January 1, 2022","tail":", the Secretary shall establish a process (in this subsection referred to as the \u201cpatient-provider dispute resolution process\u201d) under which an uninsured individual, with respect to an item or service, who received, pursuant to "},{"t":"ref","text":"section 300gg\u2013136 of this title","href":"/us/usc/t42/s300gg\u2013136","tail":", 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 \u201cuninsured individual\u201d 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 "},{"t":"ref","text":"section 1320a\u20137b(f) of this title","href":"/us/usc/t42/s1320a\u20137b/f","tail":"), 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)."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s300gg\u2013137/b","children":[{"t":"num","text":"(b)"},{"t":"heading","text":"Selection of entities"},{"t":"chapeau","text":"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\u2014"},{"t":"para","id":"/us/usc/t42/s300gg\u2013137/b/1","children":[{"t":"num","text":"(1)"},{"t":"chapeau","text":" a method to select to make such determination an entity certified under subsection (d) that\u2014"},{"t":"subpara","id":"/us/usc/t42/s300gg\u2013137/b/1/A","children":[{"t":"num","text":"(A)"},{"t":"content","text":" is not a party to such determination or an employee or agent of such party;","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s300gg\u2013137/b/1/B","children":[{"t":"num","text":"(B)"},{"t":"content","text":" does not have a material familial, financial, or professional relationship with such a party; and","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s300gg\u2013137/b/1/C","children":[{"t":"num","text":"(C)"},{"t":"content","text":" does not otherwise have a conflict of interest with such a party (as determined by the Secretary); and","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s300gg\u2013137/b/2","children":[{"t":"num","text":"(2)"},{"t":"content","text":" the provision of a notification of such selection to the individual and the provider or facility (as applicable) party to such determination.","tail":"\n"}],"tail":"\n\n"},{"t":"continuation","text":"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 \u201cselected dispute resolution entity\u201d with respect to such determination.","tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s300gg\u2013137/c","children":[{"t":"num","text":"(c)"},{"t":"heading","text":"Administrative fee"},{"t":"content","children":[{"t":"p","text":"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\u2019s access to such process.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s300gg\u2013137/d","children":[{"t":"num","text":"(d)"},{"t":"heading","text":"Certification"},{"t":"content","children":[{"t":"p","text":"The Secretary shall establish or recognize a process to certify entities under this subparagraph.","children":[{"t":"ref","text":"1"},{"t":"num","text":"1","tail":"\u202fSo in original."},{"t":"text","text":"\u202fSo in original.","tail":" Such process shall ensure that an entity so certified satisfies at least the criteria specified in "},{"t":"ref","text":"section 300gg\u2013111(c) of this title","href":"/us/usc/t42/s300gg\u2013111/c","tail":"."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"text","text":"\n"}]}]}