Claire Dawson
If you believe you've been overbilled by a hospital, there are several steps you can take to address the issue. Firstly, review your bill for any errors or duplicate charges, as these are common in medical bills. You can then compare the prices of similar procedures at other hospitals to assess whether you've been overcharged. If you have insurance, check if the procedure is covered by your plan and, if not, call your insurer's customer service line. If you still believe you've been overcharged, contact the hospital's billing department to discuss the charges and understand their complaints process. If this doesn't resolve the issue, you can file a complaint with the Hospital Bill Complaint Program or contact the hospital's CEO, CFO, or board members to highlight their predatory billing practices. If debt collectors become involved, you have the right to dispute the debt and request verification.
| Characteristics | Values |
|---|---|
| If you have insurance | Call your insurer’s customer service line if your health plan isn’t covering something you thought would be covered |
| If you have a question about the No Surprises Act or believe the rules aren't being followed | Submit a complaint to the No Surprises Help Desk |
| If you got a surprise medical bill | Reach out to the Consumer Financial Protection Bureau online or by calling 1-855-411-2372 |
| If you got a bill and haven't met your deductible | Submit a complaint to the No Surprises Help Desk |
| If you got a bill for hospital services received before January 1, 2022 | File a complaint about the hospital online through the Patient Complaint Portal |
| If you were wrongly denied financial assistance | File a complaint with the Hospital Bill Complaint Program |
| If you were sent to collections before January 1, 2022 | File a complaint about a hospital online through the Patient Complaint Portal |
| If you don't think you're medically ready to leave the hospital | Talk to the hospital discharge planner |
| If you’re covered by Medicare or by a Medicare-managed care plan | File an appeal about a discharge while you’re still in the hospital |
| If you have billing questions | Call 1-800-MEDICARE |
| If you were unfairly charged for services not rendered or egregiously overcharged for services received | Write a letter or email to the hospital’s CEO and CFO |
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What You'll Learn
Request an itemized bill
If you believe you have been overbilled by a hospital, it is within your rights to request an itemized bill. An itemized bill contains a breakdown of the procedures and services you received, along with their associated costs. It will also contain CPT (Current Procedural Terminology) or HCPCS (Healthcare Common Procedure Coding System) codes, which are industry-standard codes used to identify procedures. These codes can help you identify duplicate or incorrect charges. Hospitals are legally required to provide you with an itemized bill within 30 days of your request.
To request an itemized bill, you can call or write to the hospital's billing department. You can also use a service like Goodbill, which will request the bill on your behalf. Once you receive the itemized bill, review it carefully for any discrepancies or errors. Look for charges for services you never received or for services that were already paid for by you or your insurance company. You can also compare the prices listed on your itemized bill with the prices posted by the hospital or with prices from other hospitals.
If you find discrepancies or errors on your itemized bill, contact the hospital's billing department and dispute the charges. You may also need to contact your insurance company to discuss any discrepancies between what they have paid and what the hospital is billing you for. Keep in mind that you have the right to request an affordable payment plan if you are unable to pay the bill in full.
If disputing the charges with the hospital does not resolve the issue, you can take further action. You can submit a complaint to the No Surprises Help Desk, which will review your case and determine if your health insurance company, healthcare provider, or healthcare facility followed surprise billing rules and complied with federal laws and policies. You can also reach out to the Consumer Financial Protection Bureau, especially if you are facing unexpected out-of-network medical bills or if the bill is listed as a negative item on your credit report. There is a $25 non-refundable administrative fee to file a dispute, but if the dispute is decided in your favor, this fee will be deducted from the amount you owe.
In more severe cases of overbilling or if the hospital is unresponsive to your disputes, you can write a letter or email to the hospital's CEO, CFO, or board members to inform them of the issue. Remember that you have the right to understand and dispute any medical bills you receive, and there are resources available to help you resolve overbilling issues.
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Compare prices at other hospitals
If you believe you have been overbilled by a hospital, there are several steps you can take to address the issue. One important step is to compare the prices charged by the hospital in question with the prices of similar services at other hospitals. This can help you determine whether the charges you received are reasonable and in line with market rates. Here are some tips on how to compare prices at other hospitals:
- Utilize online tools: There are several online tools and websites that allow you to compare healthcare costs across different hospitals. Websites such as HospitalCostCompare.com enable you to search for specific inpatient or outpatient procedures and see how your local hospital's prices compare to others in the region. Healthcare Price Tool is another online resource that allows you to compare real prices from actual medical bills and find affordable, quality healthcare providers in your area.
- Check hospital websites: Starting January 1, 2021, hospitals operating in the United States are required to provide clear and accessible pricing information online. This includes a comprehensive machine-readable file with pricing details for all items and services, as well as a consumer-friendly display of shoppable services. You can use this information to compare prices for similar services at different hospitals.
- Contact hospitals directly: If you are unable to find the pricing information you need online, you can contact the hospitals directly. Ask for their pricing details, including any variations in costs for specific procedures or services. This can help you make a more informed comparison.
- Save screenshots or records: When comparing prices, remember to save screenshots or records of the pricing information you find. This documentation can be useful if you need to negotiate with the hospital or dispute the charges. It also helps to have a record of the prices quoted by other hospitals to support your case.
- Consider nearby hospitals: When comparing prices, focus on hospitals that are in the same region or area as the one you originally visited. This ensures that you are getting a true comparison, as prices may vary based on geographic location.
By comparing prices at other hospitals, you can gain valuable insights into the market rates for specific procedures or services. This information can empower you to identify potential overbilling and make informed decisions when addressing the issue with the hospital or seeking alternative options. Remember to keep detailed records of your findings and don't be afraid to advocate for yourself when it comes to your healthcare costs.
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Complain to the Hospital Bill Complaint Program
If you have received a hospital bill that you believe is incorrect or unfair, there are several steps you can take to address the issue. Firstly, it is important to review the bill for any errors or discrepancies. You can request an itemized bill from the hospital with all the billing codes listed to ensure that you have been charged correctly. If you identify any errors or discrepancies, you can dispute the bill directly with the hospital.
If you are unable to resolve the issue with the hospital directly, you can consider filing a complaint with the Hospital Bill Complaint Program. This program investigates patient complaints about hospital financial assistance, debt collection policies, and compliance with relevant laws and regulations. It is important to note that the program does not have jurisdiction over general billing and fee disputes, but it can help ensure that qualified patients have access to financial assistance and that hospitals are following proper procedures.
To file a complaint with the Hospital Bill Complaint Program, you will need to gather any supporting documentation and submit it along with your complaint. You can file a complaint online through the Patient Complaint Portal, which is the fastest and easiest way to submit your information. Alternatively, you can print and mail the Patient Complaint Form along with any supporting documents. After filing your complaint, you will receive an acknowledgement confirming that your complaint has been received.
In addition to filing a complaint with the Hospital Bill Complaint Program, you may also want to reach out to the Consumer Financial Protection Bureau, especially if you are dealing with unexpected out-of-network charges or surprise medical bills. They can be contacted online or by phone, and you will need to pay a $25 non-refundable administrative fee to file a dispute. If the dispute is resolved in your favor, this fee will be deducted from the amount you owe to the provider.
It is important to know your rights as a patient and to understand the laws and regulations surrounding medical billing. By taking the time to review your bill, dispute charges, and file complaints when necessary, you can help ensure that you are not being overbilled and that you are receiving fair and transparent pricing for your healthcare services.
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Contact the No Surprises Help Desk
If you have received a surprise medical bill, there are several steps you can take to address the issue. A surprise medical bill is an unexpected bill from an out-of-network provider or facility. Since 1 January 2022, the No Surprises Act (NSA) has protected consumers from such bills under certain circumstances.
If you have a question about the No Surprises Act or believe that the rules are not being followed, you can submit a complaint to the No Surprises Help Desk. The Help Desk can review your complaint to ensure that your health insurance company, healthcare provider, or healthcare facility followed the surprise billing rules. They can also investigate compliance with federal laws and policies and refer your complaint to another federal or state enforcement authority if necessary.
Before submitting your complaint, it is recommended that you gather any supporting documentation. You can contact the No Surprises Help Desk by calling 1-800-985-3059 from 8 am to 8 pm EST, 7 days a week, or by submitting your complaint online. The Help Desk can provide assistance in English, Spanish, and over 350 other languages.
If you have received a surprise medical bill, there are also other steps you can take before submitting a complaint to the No Surprises Help Desk. First, ask the provider or hospital for an itemized bill with all billing codes listed. Since 80% of medical bills contain errors, you may find duplicate or incorrect charges. You can then research the actual price posted by the hospital to verify that you were charged correctly. If you cannot confirm that the price is correct, you can call or write to the hospital to dispute the bill. Additionally, you can compare prices at nearby hospitals or look up the cash price to negotiate a lower charge.
If none of these steps produce results and you have been unfairly charged for services not rendered or significantly overcharged for services received, you can write a letter or email to the hospital's CEO and CFO or contact the hospital's board members to inform them of the predatory billing practices.
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Ask the hospital's billing department to explain the charges
If you believe you have been overbilled by a hospital, the first step is to contact the hospital's billing department and ask them to explain the charges. Hospital bills can be complex and confusing, so it's important to carefully review the bill and ask questions about any charges you don't understand. Here are some specific steps you can take:
- Request an itemized bill: Ask the hospital for an itemized bill that lists all the billing codes and charges separately. This will help you identify any duplicate or incorrect charges.
- Compare charges: Check that the dates and number of days on the bill match your hospital stay. Ensure you are not charged for a full day if you were admitted after midnight or discharged in the morning. Also, look out for number errors, such as extra zeros that may have been added by mistake.
- Identify double charges: Make sure you are not billed twice for the same service, medicine, or supply. If you brought your own medicines from home, confirm that you were not charged for them. Also, check that you were not billed for the brand-name version of a medicine when a generic version was prescribed.
- Question routine supply charges: Items such as gloves, gowns, or sheets should be considered routine supplies and should be part of the hospital's general costs. You should not be charged separately for these items.
- Understand costs of tests and scans: Ask the billing department to explain any charges related to reading tests or scans. These charges can sometimes be complex and vary depending on the type and number of tests or scans performed.
- Compare with insurance coverage: If you have health insurance, you may receive an Explanation of Benefits (EOB) from your insurance company. Compare the EOB with your hospital bill to ensure they match. If there are discrepancies or items you don't understand, contact your insurance company for clarification.
If, after speaking with the hospital's billing department, you still believe the charges are incorrect or unfair, you can take further steps. These may include submitting a complaint to a help desk, contacting the hospital's administration, or seeking assistance from a patient advocacy organization. Remember to keep detailed records of your communications and payments during this process.
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Frequently asked questions
First, ask your doctor or the hospital's billing department to explain the charges. Then, find out how the hospital handles billing complaints and make your case. If this doesn't work, you can write a letter or email to the hospital's CEO and CFO.
Nonprofit hospitals are required by law to offer financial assistance programs. Hospitals are also required to have a discount payment policy and a charity care policy to provide financial assistance to qualified patients. If you believe you were wrongly denied financial assistance, you may file a complaint with the Hospital Bill Complaint Program.
Debt collectors are not permitted to report a medical bill to credit reporting companies without first attempting to collect the debt from you. Ask them to verify the debt and provide information about the collector and the bill. You can also reach out to the Consumer Financial Protection Bureau online or by calling 1-855-411-2372.
Many patients are unaware that they can receive an out-of-network charge at an in-network hospital for non-urgent care. If you have insurance, check your explanation of benefits (EOB) to determine if the service or procedure is covered. Call your insurer’s customer service line if your health plan isn’t covering something you thought would be covered.
For treatments received starting January 1, 2022, you may have protections through the No Surprises Act. You should not receive unexpected bills for emergency services from a provider that you didn’t know was out-of-network until you were billed. You can submit a complaint to the No Surprises Help Desk to review your situation.
