Taking action to dispute a medical bill may seem like a daunting task.
While it’s certainly a hassle to dispute a medical bill that contains inaccuracies or surprise charges, there are a variety of steps you can take to successfully contest a bill to lower its overall cost. In this article, we’ll discuss important steps and strategies on how to dispute a medical bill as well as other important considerations before and after a visit to the doctor.
Legal Disclaimer: We are not lawyers and are not offering legal advice. This article hopes to equip you with information on how to dispute a medical bill and help you save money.
Medical bills are notorious for containing errors
Billing errors and overcharging is a remarkably common problem in U.S. health care. A study from Medliminal Healthcare Solutions found roughly four out of five medical bills contained at least some minor mistakes, costing patients and the healthcare industry about $68 billion annually.
It’s important to know that all medical bills — from regular testing to intensive surgeries — are negotiable. If you aren’t able to lower the cost of your bill by disputing it, many health care providers can offer payment plans or may be willing to lower the total cost if you pay a lump sum.
Organize your documents and take notes
To begin, collect all relevant information about your interactions with your health care provider and doctor’s visit(s) that you plan to dispute.
Collect such information as your calls or emails to providers, the times and dates, the names of people you spoke with, and what they told you. While you are disputing a medical bill, it’s unlikely that you’ll speak with the same person twice, and conveying that information can expedite the process.
Ask for an itemized bill
Call your health care provider and ask for a bill that individually details every single charge. This often is called an itemized bill or a detailed bill. Regardless of its name, it will show you every single thing — from fees to needles to procedures — that your provider is charging you.
Once you receive your itemized bill, review it carefully. This is the document where you’d be most likely find errors. Look for anything that may be out of place, erroneous, or unclear. Highlight the line items that look questionable. Jot down any questions or issues you have related to these items.
Call your health care provider
Find your medical providers’ phone number and give them a call to discuss questions on your itemized bill.
Patience and persistence are vital in this part of the process. The complexity of U.S. health care means that you’ll likely have to make many calls to reach the appropriate person that can address your questions or adjust your bill. Be clear about who you’ve spoken with, when, and what that person said regarding your dispute.
It’s not uncommon for billing disputes to be initially handled by third-parties that don’t have the authority to adjust your bill. If they’re unhelpful, ask for a supervisor. If that person isn’t helpful, ask for their supervisor or who you need to speak with that has authority to readjust your bill.
When you reach the right person to discuss your itemized bill, note any issues with your bill and ask them every question you have. They’re obliged to provide details and explanations. Make sure to take notes on their explanations, their planned course of action, what they recommend you do, and any other relevant details.
Collect evidence and supporting data
As mentioned above, you’ll likely have to make several calls to your insurance company and your provider’s billing office to resolve the billing dispute. Remember that in each call you’re making a case that you were billed in error and whenever possible provide them with evidence of the error. Make note of their responses for future calls.
One quick way to build evidence is to conduct an online search for the five-digit codes that correspond to each item on your bill. Make sure that they reflect the actual services, procedures, or tests that you were provided.
Healthcare Bluebook and FAIR Health are two helpful online cost-comparison tools that provide an estimate of typical charges for medical services in your area. While you’re searching, note any services you were provided that are significantly more expensive than other providers. Having that data can be helpful later in the process, depending on how your dispute proceeds.
For additional evidence, patients disputing a medical bill should consider asking for their medical record on file as well as their doctor’s or nurse’s notes. Check to see if there are any erroneous details and if you were billed based on that.
File an insurance appeal
If your health provider denies your billing dispute, you have the right to file an insurance appeal.
As part of your insurance company’s decision, they will provide an explanation of benefits (EOB) form. That form will explain how your insurer arrived at its decision. You have at least 180 days to file an appeal if your dispute was denied.
This guide from the Patient Advocate Foundation provides details on how to successfully navigate the appeals process and includes several example templates of how to write appeals letters.
If you lose your appeal or don’t have insurance, you can request an external review by an independent organization — such as the National Association of Independent Review Organizations — that are accredited to review health care disputes.
Ask for a patient advocate or seek third-party help
Many hospitals and health care providers have patient advocates or patient navigators that can help guide you through the healthcare system and offer recommendations on your dispute.
You can also seek out a medical billing advocate — such as the Alliance of Professional Health Advocates — for help disputing your bill. While they will likely charge you for their service, it could be worth it if you’re facing a huge bill.
If you’re facing an insurance issue, you can reach out to your state’s insurance commission. Your state’s insurance commission, which is responsible for ensuring that insurers are legally operating, may contact your insurer and or provider to discuss your dispute.
Negotiate to lower your bill
If your disputes and appeals have failed, many health experts recommend you simply ask your provider to lower the bill. Health care providers are often willing to accept less on a bill than prolonging the process or not being paid at all.
Many health care providers can offer interest-free payment plans, financial aid, or might be willing to lower the total cost if you pay the bill in a lump sum. Start by seeking a 50 percent discount by asking something like, “If I pay this bill now, can you drop the cost to … ?”
You’re not alone
One of the unfortunate realities of the U.S. medical system is that, even if you have health insurance, a simple trip to the doctor can still cost hundreds or thousands of dollars in out-of-pocket expense. And those steep medical charges can be absolutely devastating for low-income people — especially if they’re one of the 33.2 million uninsured people in the U.S.
In the last 10 years, the use of high-deductible health plans (HDHP) has skyrocketed from 25.5 percent of enrolled adults in 2011 to 43.2 percent in 2017, according to the National Center for Health Statistics.
With a high-deductible plan, a customer pays lower monthly premiums but must hit a threshold of out-of-pocket expenses before an insurance company begins covering costs. In 2020 the average annual deductible for single, individual coverage is $4,364 and $8,439 for family coverage, according to a study conducted by eHealth Insurance.
While it may come as sour solace, know that you are not alone in facing the exorbitant cost of health care. There is no shame in disputing a medical bill and you have nothing to lose by doing so.
Have patience and be persistent
Disputing a medical bill is an aggravating and often disheartening experience. Try to be as patient and persistent as possible. Most people you interact with during the course of your dispute will not know you or your specific situation and kindness can go a long way. Know that many people are successful in lowering the prices of the medical bills — and you can, too.
We hope through this article you’ve learned more about the steps to dispute a medical bill, how to interact with health care providers and insurers, and how to save more money.