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Heath Care Pricing Transparency and Consumer Rights: Disputing a charge

Disputing a charge

If there is anything about your bill that doesn't add up, or if charges seem excessive for the services provided, contact the health care provider.  If they cannot answer your questions to your satisfaction, you may ask the address for filing a dispute.  Let them know of your intention to appeal so that they can make a note of it.

Then, start keeping records of every phone call, email and letter.  Record the dates, names of those you speak with and what is said.  Get ready for a long game. There may be as much as 30 days turn-around time for each round of communication, and the full process could take months.  

If you used insurance, call the number on the back of your insurance card to ask the steps for filing an appeal with them as well.  This appeal pathway is not just for issues with the insurer, but also with providers.  To write up your argument, you may need to research the CPT and HCPCS codes on the itemized bill and make your case as to why you think the bill is wrong.  This research will take time, so se sure to check the insurance company's time limit and get your appeal submitted before the deadline.  

The appeal process may involve several rounds.   The first rounds may simply give the provider and insurer a chance to check their own work for mistakes.  If they stand by their original decisions, you may continue to the next round which would be decided by an independent third party.   Check your insurance company's website for detail on the appeals process. If you get your insurance through your workplace, your employer's Benefits office may be able to tell you more about how appeals work.

Alternatively, you can always take it to small claims court.   The "Consent to treat" forms that one signs upon registration do not show the price for services.  These are "open price contracts," and according to U.S. contract law, when signing such a contract, a buyer can only be expected to pay a price considered "usual, customary and reasonable" for the services provided.  By showing the extent to which your bill exceeds the UCR amount, you have another chance at a fair price.

Library resources

Bill due immediatelyBills "due upon receipt" often intimidate patients into paying before they've had a chance to check the bill for accuracy.  Ask the provider for specifics about when payment is actually due.  See also this article from Experian, "Can medical bills hurt your credit?" and the U.S. Federal Trade Commission's Debt collection FAQs.