Billing errors
You are entitled to the codes behind your bill
An itemized bill is where billing errors become visible. Here is how to ask for one.
A summary bill tells you what you owe. An itemized bill tells you what they did and charged you for, line by line. That is the difference between an argument you can have and one you cannot.
What to ask for
- Every charge with its CPT or HCPCS code, or revenue code.
- Units, modifiers, date of service, and amount.
- All payments and adjustments.
- The insurer and member ID they billed.
- A copy of the claim form submitted: UB-04 for hospitals, CMS-1500 for physicians.
You can cite your federal right of access to your own billing records, 45 CFR 164.524. Asking on that basis is different from asking as a favor.
What to look for once it arrives
| What to look for | What it means |
|---|---|
| Duplicates | The same code and date billed twice. |
| Overlaps | The same service on both the doctor bill and the hospital bill. |
| Services you did not receive | A test, drug, or supply you do not remember. |
| Level of care | An emergency visit coded at a high level for a quick visit. |
| Wrong dates | Charges outside your date of service. |
Ask before you accuse
“Please explain code [X] on [date] and what record supports it.”
You might be wrong. Asking is cheaper than accusing, and it is much harder for a provider to defend a vague accusation than a specific question.
Ask for a hold on collections while you wait, and say the request is not an acknowledgment that you owe anything.
Not legal, medical, tax, or financial advice. This is one
patient's experience plus general information. Rules differ by state and by plan, and
they change. Check your own documents and official sources, and decide for yourself
whether to pay any bill.