How to Dispute a Medical Bill (US)

United States

To dispute a US medical bill: request an itemized bill in writing, check every line for errors or duplicate charges, then dispute in writing citing the specific error. If your final bill is $400+ above the good faith estimate you received, file a Patient-Provider Dispute within 120 days. Nonprofit hospitals must have charity care programs under federal law.

Medical bills in the US: why errors are common

A hospital bill in the US is not a receipt — it's an opening claim from the provider that may contain errors, upcoded services, duplicate entries, or charges for items never delivered. Studies by patient advocacy organizations consistently find billing errors in the majority of hospital bills reviewed. The complexity of CPT codes, insurance adjudication, and facility fee structures creates conditions where errors go uncontested simply because patients don't know what to challenge.

The good news: federal law now gives patients specific, enforceable rights at several stages of the billing process.

Step 1 — Get the itemized bill before paying anything

Before paying any balance, request a fully itemized bill in writing (email is fine). Ask for:

Every service, supply, and procedure listed individually
The CPT (Current Procedural Terminology) billing code for each line
The date of service for each charge
The amount billed, the insurance adjustment, and the amount owed

The billing department must provide this. Keep a copy of your request. Compare the itemized bill to your Explanation of Benefits (EOB) from your insurer — the EOB shows what your insurer thinks was billed and what they paid. Discrepancies between the two are a starting point for disputes.

Step 2 — What to look for on the itemized bill

Common billing errors include:

Duplicate charges — the same CPT code appearing twice on the same service date
Upcoded services — a longer or more complex visit billed than was actually provided (e.g., a level-5 E/M code for a brief follow-up)
Unbundled charges — services that should be combined under a single code billed as multiple separate items
Charges for unreceived services — supplies or procedures in the bill that you don't recognize
Wrong diagnosis or procedure code — an incorrect ICD or CPT code that changes your coverage or cost-sharing
Incorrect patient or insurance information — a wrong date of birth or policy number can cause a claim to be denied or underpaid

If you see a charge you don't recognize, call billing first to understand it before disputing. Sometimes a charge is correctly described but confusingly named.

Step 3 — Dispute errors in writing

Call the billing department first to ask what a disputed charge represents. Then follow up in writing. Your dispute letter should:

Identify the specific line item (service date, CPT code, charge amount)
State why you believe it's incorrect
Request correction and a revised statement

Send via certified mail or email with read receipt. Keep copies. A written dispute creates a paper trail and, for No Surprises Act disputes, triggers the pause on collection action.

The No Surprises Act: what it covers

Effective January 1, 2022, the No Surprises Act protects patients from balance billing — being charged the full out-of-network rate — in specific situations:

Emergency services from any provider, regardless of network status
Non-emergency services from an out-of-network provider at an in-network facility (unless you gave prior informed written consent to the out-of-network provider's charges, which must be voluntary and given at least 72 hours in advance)
Out-of-network air ambulance services

In all three cases, your cost-sharing is capped at your in-network rate. The provider and your health plan resolve the payment difference through an Independent Dispute Resolution (IDR) process — you are not in the middle of that negotiation.

If you believe you were balance-billed in violation of the No Surprises Act:

File a complaint at cms.gov/nosurprises
Or call 1-800-985-3059

The Patient-Provider Dispute Resolution process

For uninsured or self-pay patients, providers must issue a Good Faith Estimate (GFE) before scheduled services. If your final bill is $400 or more above that estimate, you can file a Patient-Provider Dispute Resolution (PPDR) claim.

Key rules:

Deadline: file within 120 calendar days of the date on your bill
Filing fee: $25 (refunded if the dispute is decided in your favor)
File at: cms.gov/medical-bill-rights
While your PPDR is pending, the provider cannot pursue collection action against you

The IDR administrator (a certified independent entity) reviews both the estimate and the final bill and selects the appropriate payment amount. If you win, the hospital must refund the $25 fee and adjust the balance.

Financial assistance and charity care

All nonprofit (501(c)(3)) hospitals are required by IRS Section 501(r) — enacted as part of the Affordable Care Act — to maintain a Financial Assistance Policy (FAP) and make it publicly available. This is not optional: non-compliance risks the hospital's federal tax-exempt status.

What to ask for:

"Can I have a copy of your Financial Assistance Policy and the Financial Assistance Application?"

Key facts about charity care in 2026:

Many programs cover patients earning up to 300–400% of the federal poverty level (FPL) — for a family of four, that's household income up to roughly $124,800
Eligible patients may have 50–100% of their balance eliminated
Hospitals must limit charges for FAP-eligible patients to no more than the "amounts generally billed" (AGB) to insured patients — not full rack charges
If you were not told about financial assistance when you should have been, you can report the hospital to the IRS

Even if your income is above the eligibility threshold, ask about negotiated payment plans and prompt-pay discounts — most hospitals also offer these outside of the formal FAP.

If your bill goes to collections

If a hospital sends your bill to a collections agency while a dispute is active, that is potentially a violation of the No Surprises Act or state law depending on the circumstances. Document everything in writing. Escalate to:

Your state insurance commissioner (for insurance-related disputes)
Your state attorney general (for consumer protection violations)
The CFPB at consumerfinance.gov/complaint (for debt collection issues)
The CMS complaint line at 1-800-985-3059 (for No Surprises Act violations)

Related guides

For other bill negotiation strategies, see how to lower your internet bill. Browse all Summon guides for more step-by-step walkthroughs.

1
Request an itemized bill immediately
Call or email the hospital or provider billing department and ask for a fully itemized statement — every service, supply, and procedure listed with its CPT billing code and charge. The hospital must provide this; keep a copy of your written request. Review it against your Explanation of Benefits (EOB) from your insurer if you have coverage.
2
Check for common billing errors
Look for: duplicate charges (same CPT code on the same date), upcoded services (a longer visit billed than occurred), charges for services you don't recall receiving, incorrect diagnosis codes that affect coverage, and unbundled charges (services that should be billed together split into separate line items). Studies consistently find billing errors in 80% of hospital bills.
3
Dispute errors in writing
Call the billing department first to understand what each disputed charge represents, then follow up in writing. State the specific line item, the charge, and why you believe it's incorrect. Send via certified mail or email with read receipt and keep copies. While a dispute is pending, collection action must be paused under the No Surprises Act's dispute rules.
4
Check for No Surprises Act violations
If you received care from an out-of-network provider at an in-network facility, or emergency care from an out-of-network provider, you may be protected from balance billing under the No Surprises Act. You should only owe your in-network cost-sharing amount. File a complaint at cms.gov/nosurprises or call 1-800-985-3059.
5
Use the Patient-Provider Dispute Resolution process if the bill exceeds your estimate
If your final bill is $400 or more above the good faith estimate you received (required for uninsured and self-pay patients before scheduled services), you can file a Patient-Provider Dispute Resolution (PPDR) notice within 120 days of the date on the bill. The administrative fee is $25, refunded if the dispute is decided in your favor. File at cms.gov/medical-bill-rights.
6
Apply for financial assistance or charity care
All nonprofit (501(c)(3)) hospitals are required by IRS Section 501(r) to have a written Financial Assistance Policy (FAP). Ask the billing department for the hospital's Financial Assistance Application. Many programs cover patients earning up to 300–400% of the federal poverty level. For a family of four in 2026, that can mean eligibility at household incomes up to roughly $124,800.

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Frequently asked questions

What is the No Surprises Act?+

The No Surprises Act, effective January 1, 2022, protects patients from surprise out-of-network bills in specific situations: emergency services, non-emergency services from out-of-network providers at in-network facilities, and out-of-network air ambulance services. In these cases, your cost-sharing is capped at in-network rates. Providers who violate this can be reported to CMS at cms.gov/nosurprises or by calling 1-800-985-3059.

What is a good faith estimate and how do I use it to dispute a bill?+

Under the No Surprises Act, health care providers must give uninsured (or self-pay) patients a good faith estimate of expected charges before scheduled services. If your final bill is $400 or more above that estimate, you have 120 days from the bill date to file a Patient-Provider Dispute Resolution (PPDR) claim. File at cms.gov/medical-bill-rights. The $25 filing fee is refunded if the dispute is resolved in your favor.

Are nonprofit hospitals really required to have charity care?+

Yes. Under IRS Section 501(r) of the Internal Revenue Code — a requirement added by the Affordable Care Act — all 501(c)(3) nonprofit hospitals must maintain a written Financial Assistance Policy (FAP), publicize it widely, and limit charges to eligible patients to no more than the amounts generally billed to insured patients. Violation can result in loss of tax-exempt status. Ask any nonprofit hospital's billing department for their FAP directly.

What if my insurer already paid but I still owe a balance?+

Check your Explanation of Benefits (EOB) to confirm your insurer processed the claim correctly and applied your deductible, co-insurance, and out-of-pocket maximum accurately. If the insurer underpaid or incorrectly denied a portion, file an appeal with your insurer first. Many balance-billing situations are actually insurer errors rather than provider errors.

Can the hospital send my bill to collections while I'm disputing it?+

Under the No Surprises Act, if you have initiated a formal Patient-Provider Dispute Resolution (PPDR) process, the provider must pause collection actions while the dispute is pending. For informal disputes, you have more limited protection — send all correspondence certified mail, maintain a paper trail, and escalate to your state insurance commissioner or attorney general if collection proceeds during an active dispute.

What is a CARS rule?+

The CFPB's Medical Debt Collection rule (sometimes called the CARS rule or the credit reporting rule) is a regulatory proposal that would prohibit medical debt from appearing on credit reports. As of 2026, the rule's status remains contested — check cfpb.gov for the current implementation status. Some states (including Colorado, New York, and California) have already enacted state-level bans on medical debt credit reporting.

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Sources

Last updated 2026-05-27.