Get an itemized medical bill and fact-check it
Do you really owe that much? Maybe not.
Hey there —
A lot of times, medical bills aren’t just shockingly high. They’re also shockingly vague. Whether the bill comes in the mail or you’re paying online, they often don’t tell you what, exactly, you’re being charged so freaking much for.
In which case, how the heck do you know if these bills are even accurate?
A lot of the time, they’re not. People get charged all the time for medical services they did not get. Folks who fight medical bills for a living say 80 percent of the bills they see have errors in them.
And even if your bill is technically accurate, you may still have rights and options to negotiate, appeal or dispute your bill. We’ll get into that in future installments.
This is part three of our series on fighting a weird medical bill
If you’ve got insurance, a good first step is to just loop them in about any bill that looks weird to you. Sometimes it works!
But if your insurance doesn’t swoop in and fix everything, you’re gonna have to sleuth out any errors yourself.
To do that, you need to know what you’re being charged for, so you’re going to need an itemized bill.
How do you get that itemized bill?
It should be simple. Just call the billing department — whatever phone number is on your bill — and say, “I would like an itemized hospital bill, including the CPT codes.”
CPT stands for “Current Procedural Terminology," and those codes are how you figure out what the billing department is charging you for and whether those charges represent the services you actually got.1
And the law requires the billing department to give that bill to you. (It’s HIPAA,2 actually.)
But if a phone call doesn’t get you that itemized bill with CPT codes included, put your demand in writing, and cite the law.
Fellow journalist Marshall Allen wrote a helpful template you can copy into an email addressed to the billing department.
You can also let the billing office know that you’ll file a complaint with the feds if they don't comply. If you need to follow up on that threat, you can file a complaint right here.3
Give the itemized bill a reality check
Once you get it, you need to compare what’s on that bill to your own memory of what actually happened. They say doctors or nurses gave you certain meds? Maybe they did, or maybe there’s an error.
That bill may not be easy reading.
Sure, some things may be written in English, or something like it. For example, “VITAMIN B-12 LEVEL” (CPT code 82607) is probably a blood test.
But “OCCULT BLOOD FECES” (CPT code 82270) sounds like a terrible band name.
And what’s the difference between X-RAY EXAM ENTIRE SPI 1 VW (72081) and X-RAY EXAM ENTIRE SPI 2/3 VW (72082)?
This is where you’ll need to start deciphering those codes.
The official site with detailed descriptions of what each code means is paywalled. The American Medical Association (AMA) creates that stuff, and of course, they don’t give those details away.
But where there’s a will (and a search engine) there are ways.
For instance, you can search five codes a day on the AMA’s website. You’ll have to register and click through some screens. That search is enough to tell me that the “SPI 1” x-ray means “one view” (one image) and the “SPI 2/3" is two or three.
For others, you'll want more detail. Hello, Google.
Typing the words “CPT code,” plus the code number and whatever’s written on the bill into a search engine should get you some usable results. 4
But even just giving that itemized bill a first read, without dissecting every coding level, can give you information. If they’re charging you for a hospital room, is it for the right number of days? If they say you got a service … did you?
OK, I think I found an error. What now?
This is a good time to loop back with your insurance company, especially if they’re on the hook to pay a big chunk of the bill.
Again, there’s no guarantee they’ll help fix it — there are no guarantees of anything when we’re dealing with medical bills, and I’ve talked with folks whose insurance didn’t help when there were clear errors! — but there’s no reason not to try it.
If insurance doesn’t offer immediate help, it’s time to talk with the medical provider.
You may as well start out assuming it’ll be easy. Just call them and say, “I think there’s an error on my bill,” and describe the problem you see. Sometimes they’ll just fix it. Yes, really.
If they don’t address it, well, you may have a bunch of work ahead of you. It might mean some strategizing, and finding answers to some big questions for yourself:
What kind of warrior are you? What’s this fight worth to you? How are you going to take care of yourself if/when it becomes super frustrating?
And the same questions apply if the bill seems technically accurate but still totally wrong and unfair.
We’ll get into all of it over the next few months.
Bonus: Sometimes just asking for the itemized bill (maybe?) has immediate effects
We profiled Shaunna Burns on An Arm and a Leg after she made herself TikTok famous dishing out down-to-earth advice for dealing with medical bills, based on her experiences. Her daughter’s got a lot of medical issues, and they’d made a lot of trips to the emergency room.
Asking for an itemized bill was a top Shaunna tip. Shaunna said she often saw her bill immediately reduced 25 percent when she did this.
She assumed the hospital just pulled off charges that would look ludicrous. “They don’t want you to know that they’re charging you $37 for a f*cking band-aid,” she said, “so they’re going to take that charge right off of there.”
I’d keep expectations low here: This practice may have worked for Shaunna, but I’ve seen too many itemized, ridiculous charges — that hospitals defend to the death — to think that most hospitals scrub bills out of embarrassment.
But you’re gonna ask for the itemized bill anyway, right? If you happen to get an immediate gift, awesome! (And let me know about it, please. I can always use some good news.)
That’s it for part three of a series about what to do if you get a weird medical bill. There’ll be at least seven parts, one a month.
We will come back to billing codes next time, so if you have specific questions about them, let us know with a reply or a comment.
I’ll catch you here next month. Till then, take care of yourself.
Dan
Reading and resources
Journalist Marshall Allen is a fellow-traveler with lots more good bill-fighting tips in his own free newsletter and his book Never Pay the First Bill and other ways to fight the medical system and win.
We summarized all of Shaunna Burns’s medical bill tips — and linked to all her TikToks on the topic — at the Arm and a Leg website.
The ER is one place you might run into a weird bill. We wrote about how to avoid that here.
They’ll also be key to figuring out whether what you’re being charged for them is anything close to fair. We’ll get to that soon.
Yes, I know that HIPAA gets cited for all kinds of bogus stuff, but in this case it’s actually true. As described on this federal website, section 45 CFR 164.501 gives individuals — us — the right to our “personal health information,” including billing records.
Props to Marshall for digging up that link.
For instance, searching for “emergency room cpt codes” got me these very-useful guidelines from Blue Shield/Blue Cross of Minnesota. I’d want to click around for other guidelines from other insurers, as well.
Findacode.com works pretty well to get the CPT description.