Disputing mistakes on a bill is not easy for any industry, but disputing medical bills is especially difficult. However, it can be done, but should follow certain terms and conditions so that there is no possibility the hospital or doctor involved can decline on a technicality.
The dispute needs to be put in writing in a medical billing dispute letter that is sent to the billing department.
Most Billing Disputes Are Honest Mistakes
Most billing disputes are honest mistakes, which is why there is a time limit for disputes. The usual time limits are 30 to 90 days from the date of the bill.
There are also requirements for the doctor or hospital. They may not give an adverse report to a credit bureau or attempt to collect the amount in dispute unless the error is resolved or the patient paid the bill.
The following information must be given in writing according to federal requirements:
- Identification of the bill in dispute
- A written statement that the patient believes the bill is in error
- The reason the bill is being disputed
The patient needs to clearly state or give a copy of the itemized bill with the items and services that have been billed in error. Each disputed item should be listed and a request should be made that the inaccurate charges be removed.
If the hospital or doctor refuses to do this, they need to be asked for written documentation that supports the charges made.
It is recommended for every patient to keep personal notes about the services and procedures they receive from any health care giver. This is a precaution in the event there disputes later.
Follow Up With A Phone Call
The medical billing dispute letter should state that the patient expects a response within a reasonable period of time such as two weeks from the date they receive the letter. The patient may also mention that he or she will follow up with a phone call.
If the patient doesn’t get any response from the billing department, they should address the letter to the chief financial officer or chief executive office of the hospital or both.
They can state that they tried to settle the matter with the billing department but failed. Any reputable medical facility will want to make good on an error.
If, after contacting all the officials in the hospital or doctor’s office, the patient doesn’t get any help, he or she should contact the department of public health in their state. Most of these departments have consumer complaint links on their websites.
Self Pay Patient
If the patient is a self-pay patient, they should check their state’s laws about doctors and hospitals overcharging.
Patients without insurance are often charged up to four times more for the same procedure as patients with insurance. Some states have laws about how much hospitals can charge self-pay patients.
Here is a sample medical billing dispute letter. It should be sent by certified mail so that the patient or sender has proof of the time and date the letter was received.
If the dispute needs to be taken to a government agency or consumer advocacy group for help, they will require proof that the hospital or doctor has been formally asked to address the issue.
The letter should be in formal business style and copies of any invoices, bills or documents of proof of treatment need to be enclosed.
No original documents should be sent unless requested by the hospital or doctor. In this case the sender should retain a copy.
sample Medical Billing Dispute Letter
4356 Blue Street
Oakland, CA, 00000
June 1, 2022
7340 Hospital Street
Oakland, CA, 00000
Dear Billing Officer:
This letter is to formally inform you that the bill you gave me for treatment in your hospital on 05/15/2022 is inaccurate.
I received treatment for a broken arm after a motorcycle accident on that day. Technicians took x-rays and set my arm, at which time I was discharged. The bill you gave me lists an MRI scan for the cost of $1,300, which I didn’t have.
I have included a copy of the bill with the MRI cost highlighted. I have also included the record of treatment given to me when I was discharged. As you can see, I did not receive an MRI scan.
Based on this information, I request that you send me a new bill that excludes the cost of an MRI scan. I have sent this request within the 30 day limit according to the instructions given to me by you for billing disputes.
I hope to hear from you within two weeks from the date you receive this letter. I can be reached at 525-123-4557 or at firstname.lastname@example.org.
Thank you for you quick attention to this matter.
List of Enclosures