FAQ
Plain-English answers to the questions people actually ask about medical bills.
Hospital chargemaster prices are set far above actual costs — often 3-10x the Medicare benchmark rate. These inflated 'sticker prices' are starting points for insurance negotiations. If you're uninsured, you may be seeing the full chargemaster price, which is negotiable. If you're insured, your bill should reflect the negotiated rate minus what insurance paid. If it still seems high, check for errors like upcoding, duplicate charges, or facility fees.
An EOB is a document from your insurance company explaining how they processed a claim — it's NOT a bill. It shows what was charged, what insurance paid, and what you owe. Your actual bill comes from the provider. Always compare your bill to your EOB before paying. If the amounts don't match, there may be an error.
This is called split billing or facility billing. When you visit a hospital-owned clinic or outpatient center, you may receive a bill from the doctor (professional fee) and a separate bill from the hospital (facility fee). This is legal but controversial — the same visit at an independent doctor's office would typically be one bill. The facility fee covers building, equipment, and nursing overhead.
The allowed amount is the maximum your insurance will pay for a specific service. It's the negotiated rate between your insurer and the provider. If your provider is in-network, they accept this amount. The difference between the billed amount and the allowed amount is written off. Your share (deductible, copay, or coinsurance) is calculated from the allowed amount, not the billed amount.
CPT (Current Procedural Terminology) codes are 5-digit numbers that identify specific medical services. Every procedure, test, and office visit has a code — for example, 99213 is a standard office visit and 71046 is a chest X-ray. Each code has a published Medicare reimbursement rate that serves as a national benchmark. You can look up any code in our billing code library to see what it means and what it should cost.
No. Never pay a medical bill until you've received and reviewed your Explanation of Benefits from your insurance company. The EOB tells you what your insurance covered and what you actually owe. Bills that arrive before the EOB may not reflect insurance payments or adjustments. If a provider pressures you to pay immediately, ask them to wait until your claim is processed.
A facility fee is a separate charge from a hospital or hospital-owned clinic for using their building, equipment, and support staff. It's billed on top of the doctor's professional fee. As hospitals have acquired more private practices, facility fees have become increasingly common — and controversial. The same doctor visit can cost 2-3x more at a hospital-owned clinic vs. an independent office because of the added facility fee.
Studies consistently find that 30-80% of medical bills contain errors. The most common errors include duplicate charges, upcoding (billing for a more expensive service than performed), unbundling (billing separately for services that should be grouped), and charges for services never rendered. The complexity of the billing system — with over 10,000 CPT codes — makes errors almost inevitable.
Start by requesting an itemized bill with all CPT codes listed. Compare it to your EOB. If you find discrepancies, call the billing department and reference the specific line items and codes. Document every call — date, time, person's name, what was discussed. If a phone call doesn't resolve it, send a formal dispute letter by certified mail citing the specific errors. If still unresolved, you can file a complaint with your state's insurance commissioner or the CMS No Surprises Help Desk at 1-800-985-3059.
Yes. Most states allow you to dispute charges and request refunds for billing errors even after payment. There's typically no formal deadline, though acting sooner is better. Request an itemized bill, identify the errors, and contact the billing department. If they refuse to review, escalate to the hospital's patient advocate or file a complaint with your state attorney general's consumer protection division.
Upcoding is when a provider bills for a more expensive service than what was actually performed. For example, a routine 15-minute follow-up (CPT 99213, ~$92 Medicare rate) billed as a complex evaluation (CPT 99215, ~$175 Medicare rate). The biggest red flag is your ER visit being coded at Level 5 (99285) when you walked in with something minor. Compare the code level to the time you actually spent with the doctor and the complexity of your visit.
Unbundling is when a provider bills separately for procedures that should be grouped together under a single, cheaper code. For example, a surgical procedure that includes pre-operative evaluation, the surgery, and standard follow-up — all covered under one code — is instead billed as three separate services. CMS maintains the National Correct Coding Initiative (NCCI) which lists which codes must be bundled. If your bill has many small charges for what seemed like one procedure, unbundling may be the cause.
There's no universal federal deadline for disputing medical bills. Most providers allow disputes within 60-180 days. However, if a bill goes to collections, you have 30 days from the first collection notice to dispute the debt under the Fair Debt Collection Practices Act. For bills covered by the No Surprises Act, you can initiate the patient-provider dispute resolution process within 120 days. Act as quickly as possible — the longer you wait, the harder it becomes.
A strong dispute letter should include your account number, the specific charges you're disputing with their CPT codes and dates of service, why you believe each charge is incorrect (with evidence like Medicare rates or your medical records), what you're requesting (correction, adjustment, or removal), and a deadline for their response (usually 30 days). Send it by certified mail with return receipt. Keep copies of everything.
A copay is a fixed dollar amount you pay per visit (like $30 for a primary care visit). Coinsurance is a percentage of the allowed amount you pay after meeting your deductible (like 20% of a $1,000 procedure = $200). Copays are predictable and usually apply before your deductible. Coinsurance kicks in after the deductible is met and can vary widely depending on the cost of the service.
Your deductible is the amount you pay out-of-pocket before insurance starts covering costs. For example, with a $2,000 deductible, you pay the first $2,000 of covered services yourself. After that, insurance kicks in (usually paying 80% with you paying 20% coinsurance). Preventive services like annual checkups are typically covered before the deductible under the ACA. Deductibles reset each calendar year.
Your out-of-pocket maximum is the most you'll pay for covered services in a plan year. It includes your deductible, copays, and coinsurance — but not your monthly premium. Once you hit this limit, insurance pays 100% of covered services for the rest of the year. For 2026, ACA marketplace plans cap this at around $9,200 for individuals. This is your financial safety net for catastrophic medical expenses.
Common denial reasons include: the service wasn't pre-authorized, the provider was out of network, the service was deemed not medically necessary, the claim had incorrect diagnosis or procedure codes, or the service isn't covered under your plan. You have the legal right to appeal any denial. About 50% of internal appeals are successful, and external reviews (by an independent third party) overturn denials even more frequently. Most people never appeal because the process seems daunting — but it works.
In-network providers have contracts with your insurance and accept negotiated rates. Out-of-network providers have no contract and can charge whatever they want — your insurance may pay little or nothing, and you're responsible for the difference. Always verify a provider is in-network before receiving care. Remember that a hospital may be in-network while individual doctors there (anesthesiologists, radiologists) may not be.
Prior authorization means your insurance requires your doctor to get approval before performing certain services. Without it, insurance may deny the claim entirely — leaving you with the full bill. Prior authorization denials are one of the most common reasons for unexpected medical bills. Always ask your doctor if prior auth is needed, confirm it's been approved in writing, and keep documentation. If denied, your doctor can often submit a peer-to-peer review.
The No Surprises Act (effective January 2022) protects you from surprise medical bills. It bans balance billing for emergency services (regardless of network status), out-of-network providers at in-network facilities (like an out-of-network anesthesiologist at your in-network hospital), and air ambulance services. It also requires providers to give uninsured patients a good faith cost estimate before non-emergency services. If you receive a surprise bill in these situations, you can file a complaint at 1-800-985-3059.
Balance billing is when an out-of-network provider charges you the difference between their fee and what insurance paid. Under the No Surprises Act, it's now illegal in most emergency situations and when you unknowingly receive out-of-network care at an in-network facility. However, it may still be legal for planned out-of-network care where you've signed a consent form acknowledging the out-of-network status. If you receive an illegal balance bill, cite the No Surprises Act and file a complaint with CMS.
Yes, absolutely. Medical bills are almost always negotiable, especially if you're uninsured or underinsured. Strategies include: asking for the cash-pay or self-pay discount (often 20-50% off), requesting a payment plan at 0% interest, comparing your charges to Medicare rates and asking for a rate closer to the benchmark, asking about financial hardship programs, and pointing out any billing errors you've found. Hospitals are required to have financial assistance policies, and many will reduce bills for patients who ask.
Under the No Surprises Act, healthcare providers must give uninsured or self-pay patients an estimate of expected charges before providing non-emergency services. If your final bill exceeds the estimate by $400 or more, you can dispute it through the patient-provider dispute resolution process. Always request a good faith estimate before any scheduled procedure, keep it in your records, and compare it to your final bill.
Yes, but there are protections. Under current rules, medical debt under $500 cannot appear on your credit report. Paid medical collections are removed from credit reports. Unpaid medical debt can only appear after one year (giving you time to dispute and resolve). You have 30 days from the first collection notice to dispute the debt, and the collector must verify it before pursuing payment. Never ignore bills headed to collections — but don't pay a disputed amount without reviewing it first.
Yes. You have the right to request a detailed itemized bill from any healthcare provider. A summary bill that says 'Hospital Services: $8,400' tells you nothing. An itemized bill lists every single charge with the specific procedure code (CPT code) and price. Call the billing department and specifically ask for a 'detailed itemized statement with CPT codes.' They may push back — be persistent. You need this to check for errors.
You upload a photo or PDF of your medical bill. Our AI reads every billing code, translates each one to plain English, compares charges against Medicare's published national benchmark rates, and checks for common errors like duplicates, upcoding, and unbundling. You get a complete report in about 60 seconds. The analysis costs $10 — a one-time payment with no subscription.
Yes. Your bill is encrypted in transit using TLS. We don't store your bill after analysis is complete. We never sell, share, or monetize your data. We don't require your name, insurance details, or any account information. The analysis is fully automated — no human reads your bill. See our privacy policy for full details.
No. We are a consumer software tool, not a healthcare provider or insurance company. HIPAA applies to covered entities (doctors, hospitals, insurers) and their business associates. When you voluntarily upload your own document to our tool, it's similar to using a calculator or translator — you're choosing to share information with a consumer product. We still take your privacy seriously and follow strong data protection practices.
Our analysis uses official Medicare reimbursement rates published by CMS and checks against known billing rules. It's designed to catch the most common errors that cost patients money. However, it's not a replacement for a professional medical billing advocate for complex cases. We show you exactly why each item is flagged so you can make your own informed judgment. Think of it as a first pass that catches the obvious issues — which is more than most patients do.
You can upload hospital bills, doctor's office bills, lab bills, imaging center bills, Explanation of Benefits (EOBs), and itemized statements. We accept PDF files and photos (JPG, PNG, HEIC). The clearer the image, the better the analysis. For best results, upload the itemized bill (with CPT codes) rather than a summary statement.
Upload it and we'll explain every charge in plain English.
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