Step 1: Determine Whether the Dispute is Eligible
Evaluate the eligibility for the Patient-Provider dispute (ex: review all available bills and statements and context from Cases and Care Coordinators to be able to gauge if the additional services are valid(medically necessary). If the total charges are over $400 of what was quoted on the GFE and there is no additional context to make sense of the balance billing, continue to next step.
Step 2: Gather Supporting Documentation
Obtain itemized billing statements for all services being disputed, this appears to be a common request of the Independent Dispute Resolution Entity (IDRE). I’ve noticed some IDRE’s want the bill with the provider remit information represented (a real bill, not just itemization) Patient Provider disputes seem to consistently get assigned to C2C Solutions as the IDRE.
Step 3: Request Yuzu’s Assistance
Reach out to Yuzu via Slack to confirm you would like Yuzu to initiate the Patient-Provider Dispute on your behalf.
Step 4: Dispute Review and Ongoing Support
Yuzu will monitor for any incoming correspondence from the IDRE and reach out to the Care Navigators if any additional information/documentation is needed for the duration of the dispute.
What to Expect
The timeline for resolving a Patient-Provider Dispute varies and is ultimately determined by the IDRE. While Yuzu cannot control the review timeline, our experience has been that most disputes are resolved within approximately one month.
Our Experience
To date, every Patient-Provider Dispute submitted by Yuzu has resulted in a favorable outcome for the patient. While each case is reviewed independently and outcomes cannot be guaranteed, this highlights the importance of understanding and exercising your rights under the No Surprises Act.
Helpful Links
General No Surprises Act information - https://www.cms.gov/medical-bill-rights
How to Submit a Complaint - https://www.cms.gov/medical-bill-rights/help/submit-a-complaint
How to Submit a Dispute - https://nsa-idr.cms.gov/billdisputes/s/
Call CMS No Surprises Help Line: 1-800-985-3059
Visit: www.cms.gov/nosurprises