How to Contest a Medical Bill

Medically Reviewed by Dan Brennan, MD on August 16, 2021
4 min read

Medical bills are an inevitable part of life. At some point, you or someone in your family will need to see a doctor and will end up going home with a bill. Sometimes, errors and extra charges can show up on your bill. Here’s what to do if you think there are mistakes on your medical bill

Sometimes your doctor or hospital will send a bill that shows a lump sum owing. The first step in challenging your bill is to ask for an itemized copy.

When your bill is itemized, every charge is clearly listed so that you can see what you’re paying for. Go through this bill line by line. Look for double charges, coding mistakes, and incorrect calculations. 

Compare the items against your health insurance plan for charges you’re responsible for versus what your insurance company is responsible for. Then check your bill for any charges listed that should be covered by your provider.

It’s also a good idea to wait for the Explanation of Benefits report from your insurance that explains what they’ve covered for that specific date and health care visit. Make sure the bill from the hospital or doctor shows your benefits payment applied. 

If you receive Medicaid, charges should be billed directly to Medicaid, not to you. Medical providers are not allowed to charge more than Medicaid allows. If your doctor doesn’t accept Medicaid, they must tell you before the procedure and you have to agree in writing.

If you think there’s been a mistake, call your medical provider and explain why. Ask them to review the charges and fix any mistakes. ‌

Sometimes, your doctor might say that your insurance company should be covering these expenses. Ask for a letter that explains why your doctor disagrees with your insurer’s denial decision.‌

Write down the name of anyone you talk to about your bills, the date you had the conversations, and a summary of what you talked about or any decisions made. ‌

Make sure to deal with any issues right away. Most providers have a 60- to 90-day window for paying your bill. If it’s not paid within that timeline, it will get sent to a collections agency, which can harm your credit. Ask the provider not to send the bill to a collection agency while you also talk to your insurance provider. 

Carefully review your plan and talk to your insurance company. If you’re sure they should be covering the bill or reimbursing you, file an appeal. This usually has to be done quickly, within 30 to 60 days. Make sure to include your medical records, letters from your doctor that say why they disagree with the insurer’s decision to deny coverage, and any other important information.‌

Expect delays and keep detailed records of who you talk to, the date, and a summary of the conversations. This could be important if you need to file complaints with the government. 

If the bill goes to the collection agency while you are in the middle of an appeal, file a notice with the collection agency. Send a letter within 30 days stating that you're disputing the bill. Ask them not to send the matter to court while it’s being investigated.‌

Also, talk to your doctor or hospital about the dispute. If it’s an insurance problem, explain your insurance status and give information about the provider. ‌

Make sure to send all letters by certified mail with a request for return mail. Keep a copy of the letters and the postage receipt.

If your appeal is denied, try a medical advocacy agency that works with clients for free. They can work with your insurance company or your doctor to find a solution on your behalf. Check with local community resources or with a disease organization for information about medical advocates who can help you.

If these steps don't solve the problem and you end up still having to pay, you can negotiate with the medical provider. Ask for a discount and offer to send proof of income, proof of large expenses or disability that stops you from working, and other documents like tax records or bank statements. Some providers can offer up to 20% discounts right away. ‌

If you can’t pay the bill, you can talk to your doctor or hospital about financial assistance programs. You might qualify to have a portion of the bill covered.

Medical bills can be a major financial burden to families. To prevent problems, review your insurance plan and know your requirements and coverages before you get medical services.