Why You Shouldn’t Ignore a Medical Bill
Sometimes bills arrive after medical visits and don’t make sense. You may be charged by an out-of-network provider, billed twice, or receive a surprise medical bill. But you don’t have to just accept it. You have the right to dispute medical bill charges and ask questions.
Understanding Your Health Insurance Coverage
Know your health plan. It explains what services are covered, your benefits, and what you must pay. If you’re treated at an in-network hospital, your costs should be lower than at an out-of-network facility.
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Common Reasons for Medical Billing Errors
Many medical bills include errors. These may involve charges for services you’re not eligible for or treatments that weren’t provided, including:
Duplicate charges
Wrong provider name
Charges for services never received
Balance bill from an out-of-network facility
Step 1: Review Your Itemized Bill
Always ask for an itemized bill for your health care services. This will break down each service, treatment, and the billed amount, helping you verify if you’re being charged for services you’re not eligible for.
Step 2: Compare With Your EOB
Your Explanation of Benefits (EOB) from your insurer lists what your health care insurance paid and what you still owe. Match it with your bill to check for inconsistencies.
Step 3: Contact the Hospital Billing Department
If you find a problem, contact the health care provider’s hospital billing department. Ask them to explain the charges, provide documentation, and whether they have any details about your visit.
Step 4: Contact Your Insurance Company
If the provider says your insurance denied a charge, call your insurer. Ask why the claim was denied, if a network mistake occurred, or if the charge is related to a specific visit.
Common Reasons for Medical Billing Errors
Improper Medicare billing rates vary by specialty—orthopedic surgery (10.7%), otolaryngology (7.2%), and general surgery (4.0%) lead in error frequency. These errors can show up in your bills as duplicate charges or services never received. Understanding this helps patients dispute inaccurate bills more confidently and protect their finances.
Know the Difference: In-Network vs. Out-of-Network
An in-network provider has a contract with your insurance company. An out-of-network provider does not. Out-of-network charges are usually higher and can lead to surprise bills.
Emergency Services Are Protected
Under federal law, most emergency services must be billed at in-network rates, even if the provider was out of network.
The No Surprises Act: What It Means for You
The No Surprises Act protects patients from surprise medical bills from out-of-network providers at in-network hospitals.
Good Faith Estimate: Know the Cost in Advance
If you’re uninsured or using self-pay, you’re entitled to a good-faith estimate. This predicts the cost of services before your visit, so you know how much you may owe.
What If the Good Faith Estimate Was Wrong?
If your final bill is $400+ more than the good-faith estimate, you can file a dispute through the Office of Health and Human Services to challenge what you owe.
What is Balance Billing?
A balance bill is when an out-of-network provider bills you the difference between their charge and what insurance pays. This can negatively impact your credit and is illegal in many cases, especially if the provider is not properly in-network.
Surprise Billing at Ambulatory Surgical Centers
The No Surprises Act also applies to ambulatory surgical centers, offering protection from surprise bills under your health plan, even when the provider is out-of-network.
Talk to Your Provider Before You Pay
Don’t rush to pay an unclear bill. Contact your provider, ask questions, express your concerns about your health insurance coverage, and ask about available resources to help you understand the charges from that provider.
Keep Detailed Notes and Copies
Whenever you contact a provider or insurer about your health insurance, write down who you spoke to, the date, and what they said. Keep copies of all bills, letters, and forms from your provider and insurer.
File a Formal Dispute in Writing
If informal talks don’t resolve the issue, write a formal dispute letter. Include:
Your name
Account number
Description of the issue
Copies of your itemized bill, EOB, and good-faith estimate
Submit the Dispute to the Right Department
Send the dispute to both the provider and your insurance company or health plan. Use certified mail if needed.
What If You Can’t Pay Right Now?
If the bill is valid but you can’t afford it, ask the facility for:
Payment plans
Sliding scale programs
Financial aid options
Discounts for self-pay patients
Check If You Qualify for Medicaid
If your income is low, you may qualify for Medicaid, which can help cover past or future unexpected medical bills at any qualifying facility, including those from your doctor.
Contact a Medical Billing Advocate
Billing advocates can help dispute surprise medical bills, interpret health insurance rules, deal with debt collectors, and submit appeals on your behalf, especially if the charges are from a specific facility or doctor.
Use State or Federal Dispute Resolution Programs
Many states have independent dispute programs. If you’re stuck, file a complaint with:
Your state’s insurance department
The Consumer Financial Protection Bureau
The Centers for Medicare & Medicaid Services (CMS)
Medical Bills on Your Credit Report
Unpaid bills can affect your credit report and cost you money, but new rules offer protection. As of 2022:
Medical debt under $500 is not listed
Paid bills must be removed
There’s a 12-month waiting period before debt appears
Watch Out for Debt Collectors
If your bill goes unpaid, it might be sent to a debt collector. Know your rights and the options for negotiating payment before it gets to that stage, including.
They must verify the debt
They can’t harass you
You can dispute incorrect debts
Don’t Let Debt Push You to Bankruptcy
Before considering bankruptcy, explore other resources like payment plans, debt counseling, and financial assistance programs with:
Charity care
Hospital assistance programs
Nonprofit aid organizations
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What If You Already Paid?
If you paid in error, you can still dispute the charge. Ask for a refund, especially if the bill violated surprise billing protections, and keep track of any impact on your credit report or the cost of the charge.
Watch for Duplicate or Phantom Charges
Always double-check for services you didn’t receive. These can be accidental or system errors, and could result in a balance bill, increasing your overall cost.
File an Appeal with Your Insurance Company
If a claim is denied, you can submit an appeal. The steps are:
Review the denial letter
Write an appeal letter
Attach documents
Submit it on time
You Don’t Need to Handle This Alone
You can get help from a person at nonprofit resources, legal aid, patient advocates, or your state insurance office, especially if you need to file a complaint.
Ask the Facility for a Reconsideration
Hospitals and clinics often have billing review boards. Ask them to review or reconsider your bill, especially if it relates to emergency services.
Keep an Eye on Future Bills
After a dispute, patients should monitor any future bills for related services, including emergency services, to determine if they’re being charged for the same thing twice.
Final Thoughts: You Have Rights and Options
Facing a medical bill you don’t understand can feel overwhelming, but you’re not powerless. Use your rights under the No Surprises Act, request good-faith estimates, and never hesitate to dispute a charge that seems wrong to determine if it’s accurate.