Bill Dispute Tools
At BrokenHealthcare.org, we are helping patients safely and legally dispute their medical bills and force price transparency.
Our process for disputing medical bills is effective, simple and straightforward. The core of this process is to demand information we believe every patient is entitled to, but that many healthcare providers refuse to provide. This information includes price lists, an explanation of how prices are derived, bills that detail the services provided, details of their negotiations with insurance companies, uninsured discount policies, and evidence the provider is complying with price laws.
Bill Dispute Process Overview
Using our system and templates, you will simply request detailed billing information. You will indicate payment will be made once the requested information is provided. Typically, a provider will stop sending bills because it would rather lose your money than reveal details about its pricing and negotiated deals with insurance companies.
You will repeatedly assert that you will pay the bill once the provider gives you the information you are requesting.
Every letter should state, "I am disputing my bill. Please ensure my record is clearly marked disputed and be sure that should you send my bill to a collections agency, that you include a copy of all correspondence and mark the file as Disputed."
While we cannot guarantee you will never have to pay your bill, every bill is arguable.
Before You Start
- Make several copies of each your bills, or scan them for repeated use.
- Organize your bills so that you are addressing all bills related to each provider visit together.
U.S. deaths per year are caused by medical errors.
Source: Johns Hopkins
The U.S. has more hospitalizations due to preventable diseases than any other comparable nation.
Source: Commonwealth Fund study
Step 1: First Letter
Just because you signed an agreement saying you would be responsible for your bill does not mean you have agreed to pay any bill presented to you. Providers must explain their prices and how they are derived. It is insufficient for a provider to respond only that the charges are customary or based on benchmarks or standards.
Contact the provider and request four specific pieces of information:
- A detailed copy of the bill
- A copy of the provider’s price list for all related services
- An explanation of how the prices were derived
- An explanation of how any discounts were derived
Download Step One Sample Letter:
Your First Letter About Your Bill
Step 2: When the Hospital Responds
Once the provider responds to your initial letter, you will most likely need to ask for additional clarification.
- If there is not enough detail so that you fully understand the bill, ask for more detail.
- If the provider did not include a price list, explain that you are not confident that you are being billed for the right services.
- If the provider did not explain the system by which prices are derived so that you understand it, request that they try again. Do not accept that it is too complicated. Providers have an obligation to explain their prices in a manner that you understand.
- If the provider does not explain their discounts or says that you should check with your insurance company, remind them that it is the provider and not your insurance company that is sending you the bills.
- If your bill was reduced because your insurance company paid part of it, demand a copy of the agreement between the provider and your insurance company. Confidentiality between the provider and your insurance company is not a valid reason for refusing this request.
On your second letter, be sure to end with: "Because I still do not have adequate explanation of my bill, I am formally disputing this bill. Should you decide to send my bill to a collection agency, be sure to mark the file Disputed."
Download Step Two Sample Letter:
When the Hospital Responds
Step 3: Moving Forward and Beyond
The provider will likely continue to send you all kinds of explanations for why they can't answer your questions. They may tell you pricing is private or confidential. They may tell you that there are just too many events or procedures that can happen to list them all. They are likely to tell you patient care and associated charges are complicated, or are based on a system, or that they adhere to "benchmarks" and "standards". This is all nonsense and you are entitled to this information. It has been our experience that providers, particularly hospitals, will argue that they can't possibly provide all this information to every patient. This is not true.
- Be clear with the provider that you are disputing your bill and you will not pay it until you receive the information you have requested.
- Counter any argument against providing you with the requested information by asserting that you can't pay a bill without fully understanding it.
- Counter any suggestion that you seek information from your insurance company with the fact that you are disputing your provider's bill, not your insurance company's bill.
Download Step Three Sample Letters: General letter, a letter if you have received an explanation of charges, and a letter if the hospital asks for financial information