Dispute a medical bill
Medical bills are confusing, often wrong, and more negotiable than almost any other bill you'll get. Don't pay a big one until you've done these steps.
Before you start
- Get the bill from the provider and the Explanation of Benefits (EOB) from your insurer for the same visit. The EOB isn't a bill; it shows what insurance paid and what it says you owe.
- Note the account number, date of service and the billing office phone number.
- If the bill is due soon, call and ask them to put the account on hold while you review it. Most offices will.
Step 1: Ask for an itemized bill
A summary bill just shows a total. You need every line.
"Hi, I received a bill for [AMOUNT] for services on [DATE], account number [NUMBER]. Before I pay, I'd like a fully itemized bill with the billing codes for each charge. Can you send that, and put the account on hold while I review it?"
Step 2: Compare it to your EOB
Go line by line. Look for:
- Duplicates: the same test or supply charged twice.
- Things that didn't happen: a medication you didn't get, a longer stay than you had.
- A different amount than the EOB says you owe. If insurance says you owe $120 and the bill says $480, that's the first thing to ask about.
- Claims that were never sent to insurance, or were denied for a paperwork reason like a typo in your member ID.
Step 3: Call the billing office about errors
"I'm looking at my itemized bill. Line [NUMBER], [DESCRIPTION], looks like an error because [REASON]. Can you review it and correct the bill?"
"My insurer's EOB says I owe [AMOUNT], but your bill says [AMOUNT]. Can you help me understand the difference, or resubmit the claim?"
Write down who you spoke to, the date, and what they agreed to do.
Step 4: Ask about financial assistance
Nonprofit hospitals are required to have a financial assistance (sometimes called "charity care") policy, and many other providers have one too. Income limits are often higher than people assume, and some programs cover bills you've already received.
"Do you have a financial assistance or charity care program? How do I apply, and can it apply to this bill?"
Step 5: Negotiate what's left
"If I pay in full today, is there a prompt-pay discount?"
"I can't pay this all at once. Can we set up an interest-free payment plan of [AMOUNT] a month?"
Tip. Only agree to a monthly amount you can actually keep up with. Ask them to confirm the plan in writing.
Know your protections
- Surprise bills: the federal No Surprises Act generally protects you from surprise out-of-network bills for emergency care and for certain care at in-network hospitals and surgery centers.
- Good Faith Estimates: if you were uninsured or paid for care yourself and received a Good Faith Estimate, and the bill is $400 or more above it, you may be able to dispute it through the federal patient-provider dispute process. Search for it on cms.gov.
- Insurance denials: you have the right to appeal. Ask your insurer for the appeal deadline and process.
Bill negotiation kit
Scripts for medical bills plus internet, phone, insurance and credit cards, with a bill audit worksheet and a savings tracker.
One dreaded thing, made easy
This guide is general information for people in the United States, not legal, financial or medical advice. Laws and company policies change and vary by state, so confirm the details for your situation.