How often do you see the doctor? If you’re the average American, this number is four times a year. Each time you visit the doctor, you’re handed a bill, but have you ever questioned its accuracy? Knowing how to write a medical bill dispute letter can be crucial in these situations.
Some studies suggest that 8 in 10 medical bills are incorrect. This is where the medical dispute process comes in. By writing a medical bill dispute letter, you can identify these errors and avoid being unnecessarily overcharged for medical services.
Whether the bill is for an annual checkup or a hospital stay, we’ll explore some ways to craft the most effective medical dispute letter.
What Is a Medical Bill Dispute Letter?
This is a type of letter that you write to the hospital or doctor’s office to dispute what you have been charged. For instance, if you see you were charged for two X-rays but only received one, you could write a letter to dispute this.
This letter is only to dispute charges with the medical service provider, not to dispute your insurance coverage.
You can also write a medical dispute letter to dispute the cost of services if you can prove the dollar total is unreasonable. However, if you are looking for a discount or simply can’t afford the bill, writing a medical bill negotiation letter will be a better solution.
✍️ Learn more: For those navigating healthcare costs, understanding how to craft a medical bill negotiation letter can be invaluable.
Top Reasons for Writing a Medical Dispute Letter
There are two main reasons for disputing medical bills: errors and overcharging. For the best results, you’ll want to craft your letter around the reason for your dispute.
1. Billing Errors
It’s important to remember that doctors and hospital staff are just humans who are capable of making mistakes. That outrageous medical bill you received is probably not malicious. It may just be the result of a clerical error.
The most common types of billing errors include:
- Duplicate charges
- Coding errors, including upcoding
- Mistaken identity (i.e., they charged you instead of another patient with a similar name)
- Canceled procedures
- Bundled vs. unbundled pricing (i.e., receiving a discount for the full procedure)
Estimates on how frequently medical bills contain errors range from a conservative 30% up to a whopping 90%. These mistakes hit $68 billion annually just for hospital billing errors.
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2. Unreasonable Pricing
Sometimes, all the charges on your medical bill are accurate, but the final total is still outrageous. If this is the case, you can initiate a dispute based on unreasonable pricing.
To verify that the charges are, in fact, excessive, you’ll want to gather proof. If you have a previous bill for similar services that were much lower, you can use this as proof of unreasonable charges.
Another good source of proof would be an estimate of the bill for your services from either this provider or other local providers. For instance, if you compared the prices offered by several other providers and they all came in with lower totals, you could use this as evidence of unreasonable pricing.
If you don’t have previous bills and/or can’t get estimates from similar providers, you can check out the Clear Health Costs website for guidance on what charges are reasonable versus unreasonable.
💳 Learn more: Choosing the right method to settle medical debt is crucial; discover the intricacies of using loans vs. credit cards in our in-depth post.
What to Do Before Writing a Medical Bill Dispute Letter
Before writing up your dispute letter, there are a few pieces of information you’ll want to gather.
The first and most important would be obtaining an itemized copy of your bill. Medical bills are often lengthy and complicated, so you’ll need to go through the bill line by line to identify any errors.
Gathering insurance documentation can also help with your dispute. If your EOB (explanation of benefits) comes up with a different total than your medical provider, this could be a sign of possible billing errors.
As a final step, you’ll want to gather information from your provider on what needs to be in the letter. Things like patient identification numbers, billing numbers, who the letter needs to be addressed/sent to, etc.
⚠️ Warning: While gathering all needed information and documents is essential, don’t delay writing your dispute letter too long. Many hospitals and doctor’s offices have a limited dispute window (i.e., 30 days).
Sample Medical Bill Dispute Letter
City, State, Zip
Hospital or Doctor’s Name
Billing Department (optional)
Hospital or Doctor’s Address
City, State, Zip
Account or Billing ID Number
To Whom It May Concern:
This letter is to formally inform you that I am disputing charges on the bill [bill number here, or date if there isn’t a number]. This bill concerns [describe service here] performed on [date/date range]. I am disputing [bill line item] charge for [charge amount] because [reason for the dispute].
I have included [dispute proof] showing [add details]. I have also included [add details for any additional evidence you provide]. As you can see, from the information I have included, [restate what you are disputing and why].
I would like to request that you send me a revised bill where [charge being disputed] is removed (or adjusted). I hope to hear from you as soon as possible upon receiving this letter. Please contact me at [phone number] or [email address].
Thank you for your quick attention to this matter.
Account or Billing ID Number
List of Enclosures (optional)
How to Write an Effective Medical Bill Dispute Letter
The above letter is just a sample. Your medical bill dispute letter needs to be customized to your unique situation. It should also be polite and professional.
Here are the key components that your dispute letter should contain.
This info should be included in an easy-to-read section above the letter body, and it can be repeated in your letter’s introduction as well as your signature.
Include any information to help identify you and the bill(s) in question. For instance, if your hospital/doctor’s office assigns patient IDs or unique billing numbers, include this information.
Other patient and billing info, such as date of birth, bill total, service date, etc., can also be included.
👉 Learn more: Looking for a smoother way to handle medical bills? Our latest post introduces the benefits of PayZen.
Description of Dispute
Your letter intro should focus on what you are disputing and why. If you are disputing billing errors, list which items on your bill are incorrect and what type of error is involved (i.e., duplicate charge).
For instance, “I am disputing the 2nd chest X-ray charge because it is a duplicate charge.”
If you are disputing based on unreasonable pricing, you’ll want to state upfront why you believe the charges are unreasonable. For instance, “I am disputing the MRI charge because the total was $800 more than the original estimate.”
👉 Learn more: Considering consolidating medical debt? Here’s a deep dive to help you make an informed decision.
Proof of Dispute
Once you’ve outlined what you are disputing and why, you’ll need to offer evidence to support your claim.
You can reference the medical bill for specific errors, like duplicate charges. I.E., I have included a highlighted copy of the itemized bill showing the duplicate charges.
Other errors may require additional evidence. For instance, in cases of mistaken identity, you may need to prove who you are and offer evidence that you did not receive the medical services charged.
For pricing-based disputes, you can cite any original estimate you received, prior bills for the same service, or a website like Procedure Price Lookup. I.E., “I have included the estimate from XYZ provider showing that a cost of $500 for this service would be fair.
Request for Contact
The last bit of your medical bill dispute letter should include a request for a revised bill and instructions on how you wish to be contacted. For instance, “I would like to request that you send me a revised bill where the MRI charge is appropriately adjusted.”
You can also include a timeframe in your medical bill dispute letter for when you would like to be contacted, i.e., 30 days. Just remember to be polite and set a reasonable timeframe.
What to Do Once You Have Sent the Letter
Once you’ve sent the letter, you’ll want to follow up to verify that the letter was received. Even if you sent the letter by certified mail, you’ll still want to double-check.
If your letter has been received and an investigation opened, you’ll want to know what this means. Is the due date on hold? Can you continue receiving services from this provider? How long will it be before they come to a decision?
You’ll want to keep a record of all communication; this can include saving copies of emails as well as noting down the time and date of phone calls and who you spoke with.
Just remember the dispute and investigation process can take time. Frequent contact is OK, but calling or emailing daily likely won’t accomplish much.
What to Do When Your Dispute Is Accepted
Congrats, the hospital or doctor’s office has agreed with you and approved your dispute. If they haven’t already provided it, request a revised copy of the itemized bill showing your new total.
Save any communication you receive during the dispute process to ensure the incorrect bill isn’t charged against you again later.
What to Do When Your Dispute Is Rejected
If the hospital or doctor’s office outright rejects your dispute or is simply unresponsive, there are additional steps you can take.
If you have proof of an actual billing error, it may be time to escalate the issue to a supervisor, contact a patient advocate, or submit a complaint to state regulators. Speaking with an attorney is also a last-resort option.
When the dispute was due to unreasonable pricing, you could try an alternate route. Specifically, the No Surprises Act offers a dispute process when your charges are $400 or more over the original estimate.
If you didn’t receive an estimate, and the provider won’t budge on their pricing, it may be time to pursue other options for negotiating your medical bill.
👉 Learn more: Unpacking the “No Surprises Act”: Learn how it’s changing the landscape of unexpected medical costs.
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