Medical Bill Disputes: How to Fight Unfair Charges

Medical billing errors are shockingly common - some studies suggest up to 80% of medical bills contain mistakes. Whether you're dealing with billing errors, surprise charges, or bills you simply can't afford, you have more options than you might think to reduce or eliminate what you owe. For official guidance on medical debt and your rights, visit the CFPB Medical Debt resource.

Common Medical Billing Problems

Billing Errors

• Duplicate charges for the same service
• Charges for services not received
• Incorrect billing codes (upcoding)
• Wrong patient information
• Services billed separately that should be bundled

Insurance Issues

• Services wrongly denied as not covered
• Out-of-network charges for in-network facilities
• Balance billing violations
• Failure to apply correct negotiated rates

Surprise Bills

• Emergency room charges at out-of-network hospitals
• Out-of-network providers at in-network facilities
• Air ambulance charges
• Anesthesiologist or radiologist bills

Federal Protections

No Surprises Act (2022)

This law protects patients from:

• Surprise bills for emergency services
• Out-of-network charges at in-network facilities without consent
• Air ambulance bills from out-of-network providers

How It Works

• You only pay in-network cost-sharing amounts
• Providers and insurers must negotiate
• Independent dispute resolution if they can't agree
• Good faith estimates required for uninsured patients

HIPAA Billing Rights

• Right to receive itemized bills
• Right to request billing records
• Right to dispute inaccurate information

Step-by-Step Dispute Process

Step 1: Request an Itemized Bill

You have the right to a detailed breakdown:

• Each service with CPT/procedure code
• Date of service
• Provider who performed service
• Amount charged for each item

Step 2: Review for Errors

Look for these common mistakes:

• Services you didn't receive
• Duplicate charges
• Incorrect dates of service
• Wrong diagnosis codes
• Charges that should be covered by insurance

Step 3: Compare with EOB

Your Explanation of Benefits should match the bill:

• What your insurance paid
• What they denied and why
• What you're responsible for
• Negotiated rates vs. billed amounts

Step 4: Contact the Billing Department

• Call during business hours
• Document who you speak with
• Ask specific questions about charges
• Request corrections in writing

Step 5: File a Formal Dispute

If informal resolution fails:

• Send written dispute letter
• Include specific errors identified
• Attach supporting documentation
• Request response within 30 days

Negotiating Medical Bills

When to Negotiate

• You're uninsured or underinsured
• Bill exceeds reasonable rates
• You can't afford the full amount
• After disputing errors unsuccessfully

Negotiation Strategies

• Ask for cash discount: Often 10-40% off
• Request Medicare rate: Usually much lower than billed
• Offer lump sum payment: For larger discount
• Request payment plan: Interest-free options
• Apply for financial assistance: Most hospitals have programs

What to Say

• "I can't afford this amount"
• "What discount do you offer for prompt payment?"
• "Can you reduce this to the Medicare rate?"
• "Do you have a financial assistance program?"

Hospital Financial Assistance

Non-profit hospitals must offer charity care programs:

Eligibility

• Based on income relative to federal poverty level
• Usually covers those at 200-400% of poverty level
• May reduce bill by 50-100%

How to Apply

1. Ask billing department for application
2. Provide income documentation
3. Submit before collection action
4. Appeal if initially denied

Insurance Appeals

If your insurance denied coverage:

Internal Appeal

• File within 180 days of denial
• Request your claim file
• Submit supporting medical records
• Get doctor's letter of medical necessity

External Review

• Available after internal appeal denied
• Independent third-party review
• Decision is binding on insurer
• Free to patients

Protecting Your Credit

Recent Changes

• Medical debt under $500 removed from credit reports (2023)
• Paid medical debt removed immediately
• One-year waiting period before reporting

If Sent to Collections

• Request debt validation within 30 days
• Dispute inaccurate amounts
• Negotiate pay-for-delete agreement
• Know your state's statute of limitations

State-Specific Protections

Some states have additional protections:

• California: Hospital charity care requirements, rate caps
• New York: Surprise bill protections, income-based caps
• Colorado: Hospital price transparency requirements
• Texas: Surprise billing mediation
• Illinois: Hospital fair pricing policies

When Bills Are Clearly Wrong

Common Fraud Indicators

• Charges for services never provided
• Billing for more expensive procedures than performed
• Unbundling services that should be packaged
• Charging for brand-name when generic used

Where to Report

• Your state insurance commissioner
• State attorney general's office
• Medicare (for Medicare fraud): 1-800-HHS-TIPS
• Hospital patient advocate