Introduction
Medical billing errors are surprisingly common — studies suggest that the majority of medical bills contain at least one error. Whether you have been charged for services you did not receive, billed at the wrong rate, or denied coverage you believe you are entitled to, you have the right to dispute a medical bill. This guide walks you through the process step by step.
Step 1: Request an Itemized Bill
Always start by requesting a fully itemized bill from the hospital or provider. This lists every charge individually — every medication, procedure, supply, and service — along with the corresponding medical codes. You are legally entitled to this document. Compare it carefully against your own records of what services you actually received.
Step 2: Request Your Explanation of Benefits (EOB)
If you have health insurance, request your Explanation of Benefits from your insurer. The EOB shows what your insurer was billed, what they paid, what they denied, and what you owe. Compare the EOB against your itemized bill — discrepancies between the two are common and worth investigating.
Step 3: Look for Common Billing Errors
When reviewing your itemized bill watch for:
- Duplicate charges — being billed twice for the same service
- Upcoding — being billed for a more expensive procedure than was performed
- Unbundling — services that should be billed together are billed separately at a higher total cost
- Incorrect patient information — wrong insurance ID, date of birth, or diagnosis code
- Services not rendered — charges for procedures or medications you did not receive
- Operating room or facility fees that seem excessive or unexplained
Step 4: Contact the Billing Department
Call the provider’s billing department and ask them to explain any charges you do not understand. Keep detailed notes of every conversation including the date, time, and name of the person you spoke with. Many errors are corrected at this stage simply by pointing them out.
Step 5: File a Formal Dispute
If the billing department does not resolve the issue, file a formal written dispute. Your letter should:
- Identify the specific charges you are disputing
- Explain why you believe the charge is incorrect
- Include copies of supporting documents (EOB, itemized bill, medical records)
- Request a written response within a specific timeframe (30 days is reasonable)
- Be sent via certified mail so you have proof of delivery
Step 6: Appeal Your Insurance Denial
If your insurer denied a claim you believe should be covered, you have the right to appeal. Under the Affordable Care Act, insurers must provide a clear appeals process. There are two levels:
- Internal appeal — ask your insurer to review the denial decision
- External review — an independent third party reviews the denial if your internal appeal is unsuccessful
Your insurer must respond to an internal appeal within 30 days for non-urgent care and 72 hours for urgent care.
Step 7: Ask for Financial Assistance
Even if the bill is accurate, you may be able to reduce what you owe. Many hospitals — especially nonprofit hospitals — are required to offer charity care or financial assistance programs. Ask the billing department about:
- Financial assistance or charity care programs
- Sliding scale fees based on income
- Interest-free payment plans
- Prompt pay discounts for paying in full quickly
Step 8: Get Help if Needed
If you are unable to resolve the dispute on your own, consider these resources:
- Patient advocate — many hospitals have patient advocates who can help resolve billing disputes
- Medical billing advocate — a professional who reviews bills and negotiates on your behalf, typically for a percentage of the savings
- State insurance commissioner — if your insurer is acting in bad faith, file a complaint with your state’s insurance regulatory agency
- Consumer Financial Protection Bureau (CFPB) — if a debt collector is pursuing you for a disputed medical bill, file a complaint at consumerfinance.gov
What About Medical Debt in Collections?
As of 2023, medical debt under $500 no longer appears on credit reports from the three major bureaus. Larger medical debts must be at least one year old before appearing on your credit report, giving you more time to resolve disputes before your credit is affected. If a medical debt in collections is inaccurate, you have the right to dispute it directly with the credit bureaus.
The information on LegalConsultants.com is provided for general informational purposes only and does not constitute legal or financial advice. Always consult a qualified attorney or financial advisor for advice specific to your situation.