Orlando Harmon
Medical billing can be a confusing and unclear process, with patients sometimes receiving bills that are incorrect or inaccurate. If you have insurance, you can call your insurance company to find out whether they have received and acted on the bill, and how much they will be paying. If you are unsure whether you owe a bill, it is important to check that the bill is yours, that your name, insurance information, and billing address are correct, and that the items on the bill are accurate. If you have a problem with debt collection or credit reporting due to a surprise medical bill, you can submit a complaint with the CFPB online or by calling (855) 411-CFPB (2372).
| Characteristics | Values |
|---|---|
| What to do if you can't pay a medical bill? | Make sure the provider accurately calculated the bill and that you owe it before you pay. There may also be financial assistance or "charity care" that you can avail. |
| What to do if you received a surprise medical bill? | The No Surprises Act (NSA) protects you from surprise billing if you have health insurance and provides some protections if you are uninsured. |
| What to do if you received a bill with incorrect charges? | Request an itemized statement from the clinic or hospital. If the itemized statement contains services you never received, call or write to the clinic or hospital to point out the discrepancy. |
| What to do if you received a bill that you think your insurance company should have paid? | Call both the clinic/hospital and insurance company to see if there is still time for the claim to be processed. Ask about your obligation to pay the bill if the clinic/hospital’s delay in filing a claim caused the claim to be denied. |
| What to do if you received a bill without a good faith estimate? | You can submit a complaint if your provider didn’t give you a good faith estimate. |
| What to do if you received a bill that you think violates the No Surprises Act? | Appeal your bill. Follow the process described in your plan's documents and denial notices. |
| What to do if you want to dispute a medical bill? | Reach out to the Consumer Financial Protection Bureau online or by calling 1-855-411-2372. You’ll need to pay a $25 non-refundable administrative fee to file a dispute. |
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What You'll Learn
Understanding your medical bill
Firstly, make sure the bill is addressed to you and shows your correct name, insurance information, and billing address. Check the statement date and the name and address of the provider(s) or facility. This will help you understand which provider or facility is billing you. If you don’t see your provider’s or facility’s name or medical practice on the bill, or you see a different name, call the number on your bill and ask them about it.
Next, review the services or supplies listed on the bill. Make sure they are the ones you received on the dates stated. Sometimes the descriptions are very general, have abbreviations, or include complex medical terms or billing codes. If you don’t understand the listed service or supply, contact your provider or facility and ask for a plain language explanation. Also, make sure you are not billed twice for the same service, medicine, or supply. If you brought your own medicines from home, check that you were not charged for them. If a generic medicine was prescribed, make sure you are not billed for the brand-name version.
Check the costs of the services or supplies. The total charges refer to the full price for the service(s) and/or item(s). The allowed amount refers to the maximum amount a plan will pay for a covered health care service. If your provider is out of network and charges more than the plan’s allowed amount, you may have to pay the difference. If you have health insurance, you should receive an Explanation of Benefits (EOB) from your health plan before you get a medical bill. The EOB will show the costs of your care, including the services you got and the date you got them, the amount your health plan agrees to pay, and the amount you owe (if anything). Compare the amount on your medical bill to the amount the EOB says you owe to ensure accuracy. If you don’t receive an EOB, contact your health plan to ensure your provider’s office has sent them a claim for your service.
If you don’t have health insurance, your provider must give you a “good faith” estimate of how much your care will cost before you get the care. If the billed amount is $400 or more above the estimate, you may be able to dispute the charges. If you are unable to afford the bill, talk to the medical care provider. Nonprofit hospitals are required by law to offer financial assistance programs, and many other providers are willing to work out payment arrangements.
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Disputing a medical bill
If you have a medical billing issue, you can answer a few questions to find an action plan that works for you. You can also call your insurer's customer service line if your health plan isn't covering something you thought would be covered. If the bill should be covered according to your EOB and the insurance company is refusing to pay, contact the National Association of Insurance Commissioners. If you have health insurance through your employer, you can also ask your Human Resources Department to advocate on your behalf.
If you received medical care on or after January 1, 2022, and you didn't have or didn't use your health insurance to pay for it, your provider must give you a "good faith" estimate of how much your care will cost before you get it. If the billed amount is at least $400 more than the estimate, you may be eligible to dispute your bill through the patient-provider dispute resolution process. In this case, an independent third party will review your bill and determine an appropriate payment. You and your healthcare provider or facility can settle on a payment amount before the dispute process ends. They may offer to reduce your bill, or you may agree to pay the billed amount in full. If you and your provider agree on a payment amount, they must reduce your bill by at least $12.50 (half of the $25 administrative fee) and notify the independent third-party reviewer that you've reached a settlement.
If your bill is already in collections, your provider or facility must stop pursuing payment until the dispute process is resolved. You can take action if a debt collector contacts you about an unexpected out-of-network medical bill or if you see a surprise medical charge listed as a negative item on your credit report. You can reach out to the Consumer Financial Protection Bureau online or by calling 1-855-411-2372. You’ll need to pay a $25 non-refundable administrative fee to file a dispute. If the dispute is decided in your favor, the $25 will be deducted from the amount you owe your provider.
For issues with medical debt collections and credit reporting, you can submit a complaint to the CFPB. If you have a question about the No Surprises Act or believe the law isn't being followed, you can contact the Centers for Medicare & Medicaid Services No Surprises Help Desk at (800) 985-3059 from 8 a.m. to 8 p.m. ET, seven days a week, to submit a question or a complaint. You can also submit a complaint online.
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Your rights and protections
If you are facing medical billing issues, it is important to know your rights and protections. Here are some key points to be aware of:
Understanding Costs and Insurance Coverage: You have the right to clear and accurate information about the costs of different medical procedures and what is covered by your insurance. If you don't have insurance, providers must give you a "good faith estimate" of the expected costs before providing treatment. This estimate should be provided in advance, especially if you schedule care ahead of time or specifically request an estimate.
Disputing Unexpected Charges: If you receive a bill that is significantly higher than expected or includes unexpected out-of-network charges, you have the right to dispute it. The No Surprises Act, a federal law effective as of January 1, 2022, protects you from unexpected out-of-network medical bills in most cases. This includes emergency room visits, non-emergency care at in-network facilities, and certain other situations. If you believe your bill violates this law, you can submit a complaint to the Centers for Medicare & Medicaid Services.
Accuracy of Billing: You have the right to receive accurate and transparent medical bills. Review your bills closely to ensure that the items listed are correct and reflect the treatments you received. Verify that the bill contains your correct name, insurance information, and billing address. If there are unclear or questionable charges, ask your provider for a clear and detailed explanation.
Debt Collection Practices: If you are contacted by debt collectors regarding your medical bills, they must comply with certain laws and regulations. They cannot harass or abuse you, and they must follow specific reporting requirements when informing consumer reporting companies about your debt. You have the right to ask debt collectors to verify the debt, provide information about the collection agency, and stop contacting you if you believe your rights are being violated. Additionally, debt collectors cannot report medical debt to credit reporting companies without first attempting to collect the debt directly from you.
Financial Assistance and Payment Arrangements: If you are unable to afford your medical bills, nonprofit hospitals are legally required to offer financial assistance programs. Other medical providers may also be open to negotiating payment arrangements. Reach out to your state or local social services to explore additional sources of financial assistance.
Remember, it is important to stay informed about your rights and protections in medical billing. If you have concerns or believe your rights are being violated, don't hesitate to seek assistance from relevant government agencies or consumer protection organizations.
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The No Surprises Act
The Act establishes protections for consumers against surprise billing, which is an unexpected balance bill. This can occur when a patient receives care from an out-of-network provider or facility, even unknowingly, and their health insurance plan does not cover the entire out-of-network cost. The Act also applies to emergency services, where a patient may not be able to choose their provider or facility and could, therefore, be at risk of receiving a surprise bill.
The Act also establishes independent dispute resolution processes for payment disputes between health plans and providers. It provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a bill that is substantially higher than the good faith estimate provided by the provider.
If you believe that your insurance company or provider is not following the rules of the No Surprises Act, you can submit a complaint to the Centers for Medicare & Medicaid Services No Surprises Help Desk online or by calling 1-800-985-3059.
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Financial assistance
If you're facing medical billing issues, you can call your insurance company to discuss the problem and try to resolve it. Review your medical bills to ensure that the items listed are accurate and that you received the treatments mentioned. Also, verify that the bill has your correct name, insurance information, and billing address. You can request a plain-language explanation from your provider for any unclear items on the bill.
If you're unable to resolve the issue with your insurance company, you can explore financial assistance options to help with your medical bills. Financial assistance programs, sometimes referred to as "charity care," offer free or discounted healthcare services to individuals struggling to pay their medical expenses. These programs are designed to assist both uninsured and underinsured individuals. Hospitals, particularly nonprofit hospitals, are often required by law to provide financial assistance or have policies in place to help patients with their medical bills. Check with your hospital to understand their financial assistance policy, including eligibility criteria and the application process.
Additionally, government programs like Medicare, Medicaid, the Children's Health Insurance Program (CHIP), the Affordable Care Act (ACA), and COBRA can provide support with health expenses. Medicare Savings Programs, for instance, can help with Part A and Part B premiums, deductibles, coinsurance, and copayments. Meanwhile, Medicare Extra Help assists with Part D costs for prescription drugs. If you're already receiving coverage from any of these programs, there may be additional support available.
State governments and local social services agencies also play a role in providing financial assistance for medical bills. Certain states, like Colorado, Massachusetts, and South Carolina, have state-run financial assistance programs. State agencies, such as the state attorney general, state insurance department, or insurance commissioner, can offer valuable information and guidance on resolving medical billing issues. They can also assist with submitting complaints if you believe your rights are being violated.
If you're facing challenges with debt collection related to medical bills, you have certain rights that protect you. Debt collectors must comply with specific laws, including refraining from harassing or abusive calls and respecting your request to stop contacting you. They are also required to verify the debt and ensure that it is valid before initiating collection efforts. If you suspect that a debt collector is violating your rights, you can take action to enforce those rights and submit a complaint to the Consumer Financial Protection Bureau (CFPB).
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Frequently asked questions
If you can't pay a medical bill, make sure the provider accurately calculated the bill and that you owe it before you pay. There may be financial assistance programs or protections under federal and state law that you can avail yourself of. Nonprofit hospitals are required by law to offer financial assistance programs, and many other providers are willing to work out payment arrangements.
The No Surprises Act is a federal law that went into effect on January 1, 2022. It applies to most types of health insurance and protects you from unexpected out-of-network medical bills. If you believe that your insurer isn't following these rules, you can call the No Surprises Help Desk at 1-800-985-3059 to submit a question or a complaint.
You may request an itemized statement from the clinic or hospital. If the itemized statement contains services you never received, call or write to the clinic or hospital to point out the discrepancy. You can also submit a complaint to the Consumer Financial Protection Bureau online or by calling 1-855-411-2372.
