Medical Bill Disputes

Step 1 — Request an itemized bill

A "summary" bill showing only a total amount owed is not enough to dispute. Request an itemized bill showing each service, each CPT or procedure code, each charge, and each adjustment. Providers must provide itemized bills on request. Include:

• Dates of service
• Description of each service
• Billing codes (CPT for procedures, ICD-10 for diagnoses, revenue codes)
• Charge amount
• Insurance payment or adjustment
• Patient responsibility

Step 2 — Get your Explanation of Benefits (EOB)

Your insurer sends an EOB for each claim. The EOB shows what the provider billed, what the insurer paid (or declined to pay and why), and what your responsibility is. Do not confuse the EOB with a bill — EOBs typically say "THIS IS NOT A BILL."

If you cannot find an EOB, log into your insurer's portal or call member services. EOBs are usually available online within days of claim processing.

Step 3 — Compare and identify discrepancies

Cross-reference the itemized bill against the EOB. Look for:

• Services you did not receive — the most common error
• Duplicate charges — the same service billed twice
• Upcoding — a more complex (and expensive) code than the service actually performed
• Unbundling — charging separately for services that should be bundled at a single code
• Wrong rate — charges that don't match the insurer's contract with an in-network provider
• Out-of-network billing on in-network services — often a No Surprises Act violation
• Balance billing — the provider charging you the difference between their charge and the insurer's allowed amount, when they shouldn't
• Coordination of benefits errors — if you have two insurers, one may not have been billed

The No Surprises Act

Effective January 1, 2022, the No Surprises Act protects patients from unexpected out-of-network bills in several scenarios:

• Emergency services — you cannot be balance billed for emergency care, even if the emergency provider is out-of-network
• Out-of-network providers at in-network facilities — you generally cannot be balance billed for ancillary providers (anesthesiologists, radiologists, pathologists, hospitalists) when you are at an in-network hospital or surgical facility
• Air ambulance services — balance billing prohibited

If you believe you were improperly balance billed, file a complaint with the CMS No Surprises Help Desk at 1-800-985-3059 or at cms.gov/nosurprises. The help desk helps with independent dispute resolution and can direct you to state resources.

Self-pay and financial assistance

If you do not have insurance or the bill is for a non-covered service:

501(r) financial assistance (nonprofit hospitals)

All 501(c)(3) nonprofit hospitals must maintain a written financial assistance policy, screen patients for eligibility, and limit charges to patients who qualify. Many hospitals offer 100% free care for patients below specific income thresholds (typically 200–400% of federal poverty level). Ask for the financial-assistance application — they are required to have one.

Self-pay discount

If you are uninsured or paying out-of-pocket, ask for the self-pay discount or cash-pay rate. It is typically 30–70% lower than the chargemaster rate.

Payment plan

Most providers offer interest-free payment plans. Negotiate one before the debt is sent to collections.

Negotiating down

Large bills can often be negotiated. Start by asking for the financial-assistance rate or the Medicare rate for the same service. Explain your situation in writing. Providers often reduce bills significantly for patients who ask.

Sample dispute-letter structure

A medical-billing dispute letter usually includes:

1. Patient name, account number, date of service
2. Specific disputed charges (by code and date)
3. Basis for the dispute (service not received, duplicate, upcoding, No Surprises Act, etc.)
4. Supporting documentation (EOB, prior statements, medical records)
5. Request for corrected billing
6. Statement that you dispute the debt and are not admitting liability
7. Request that the debt not be reported to credit agencies during the dispute

Send by certified mail with return receipt. Keep copies of everything. You can use the dispute-letter generator on this site as a starting point — review with an attorney or patient advocate before sending for large amounts.

Medical debt on your credit report

Recent rules have changed how medical debt affects credit:

• Paid medical debt no longer appears on credit reports
• Unpaid medical debt does not appear for the first year after it goes to collections
• Medical debt under $500 does not appear on credit reports
• Additional CFPB rules proposed or finalized have further limited medical debt reporting

If medical debt appears on your credit report in violation of these rules, dispute it under the Fair Credit Reporting Act.

Hospital bills and Medicaid retroactive coverage

If you received emergency care and were uninsured but may have qualified for Medicaid, apply for retroactive Medicaid coverage. Illinois Medicaid can cover medical bills up to three months before the application date if you were eligible during that period. Ask the hospital's financial-assistance office for help with the Medicaid application — they have an incentive to help you qualify.

Free help

• CMS No Surprises Help Desk — 1-800-985-3059
• Illinois Attorney General — Health Care Bureau — 877-305-5145
• Patient Advocate Foundation — patientadvocate.org
• Dollar For — helps navigate hospital financial-assistance programs. dollarfor.org
• Legal Aid Chicago — Health & Disability — 312-341-1070