Frequently Asked Questions

CPT (Current Procedural Terminology) codes are a standardized set of five-digit numbers used by medical professionals to describe the specific services and procedures they performed. This allows for consistent billing across the US healthcare system.

Yes, you can and should dispute any bill that seems incorrect. Start by requesting an itemized bill, checking for errors, and then contacting the hospital's billing department to formally dispute specific line items.

An EOB is a document sent by your insurance company after you receive medical services. It is not a bill. It shows what the provider charged, what the insurance covered, and what your remaining responsibility (co-pay, deductible) might be.

Hospitals often use 'chargemasters'—a list of prices that are significantly inflated compared to retail costs. These prices are often the starting point for negotiations with insurance companies, but unfortunately, they are often what is billed to uninsured or underinsured patients.

Upcoding is a type of medical billing fraud where a provider uses a code for a more expensive service than what was actually performed (e.g., billing for a complex visit when only a simple one took place).

The No Surprises Act is a federal law that protects patients from 'surprise' medical bills when they receive emergency care or are treated by an out-of-network provider at an in-network facility without their prior consent.

Don't panic. You can still negotiate with collection agencies. Ask for 'verification of the debt' and offer a one-time settlement for a percentage of the total. New credit reporting rules also mean most medical debt under $500 won't appear on your credit report.

Charity Care (or Financial Assistance) is a program mandated for non-profit hospitals that provides free or discounted care to patients who meet certain income requirements (often up to 400% of the federal poverty level).

Look for five-digit CPT codes. Use our decoder tool to see what those codes mean. Compare the descriptions to what you remember happening during your visit.

A facility fee is a charge for the 'overhead' of the building (hospital, ER, or clinic). These are often the largest and most frustrating parts of a bill because they don't represent a specific medical service.

It is much harder to negotiate after payment because you've lost your leverage. However, if you find a clear error later, you can still request a refund from the hospital.

Balance billing is when a provider bills you for the difference between what they charged and what your insurance company paid. This is now illegal in many 'surprise' scenarios under federal law.

Wait until you receive the final EOB from your insurance and compare it to the hospital's bill. If they don't match, don't pay until you've spoken to both the insurer and the hospital.

If the hospital offers a 'prompt pay' discount (often 10-20% off if paid in 30 days), it may be better to pay in full if you have the funds. Otherwise, a 0% interest payment plan is a better way to manage cash flow.

You can contact your state's Insurance Commissioner, the Consumer Financial Protection Bureau (CFPB), or hire a professional medical billing advocate.