Bill dispute, payment plan

Health care bills in the U.S. are complicated and can be incorrect. Checking the bill before paying it, appealing an insurance denial, using your federal rights against surprise bills, and asking the hospital for financial assistance or a payment plan can often significantly reduce your debt. On this page, you will find step-by-step bill review instructions, insurance appeal deadlines, No Surprises Act protections, the $400 rule for uninsured patients, and official lines to contact.

1. Ask the provider’s billing department for an itemized bill.
2. If you are insured, ask your insurer for an Explanation of Benefits (EOB). The amount on the bill should match the “your share” or “Patient Balance” amount on the EOB.
3. Ask for a copy of your medical records and compare them with the bill. A service that is not in the records should not appear on the bill. Some providers may charge a fee for records.
4. Check whether the same service was billed twice. This error is more common if you received services from more than one provider.
5. Check whether the procedure codes on the bill, such as CPT codes, match the services you received.
6. If you see a problem, call the billing department. Note the name of the person you speak with and the reference number.

• Internal appeal:
  • If an insurer denies a claim, it must notify you in writing and explain the reason: within 15 days for prior authorization requests, 30 days for services already received, and 72 hours in emergencies.
  • You must appeal within 180 days (6 months) after receiving the denial notice.
  • Complete the insurer’s appeal form or send a letter containing your name, claim number, and insurance ID number. Include supporting documents, such as a letter from your doctor.
  • The insurer must decide an appeal within 30 days for services you have not yet received and within 60 days for services you have received.
• External review:
  • If the internal appeal is denied, you can request a review by an independent organization in writing within 4 months after the final denial notice. The insurer must comply with the external review decision.
  • In a standard review, a decision is made within 45 days at the latest; in an expedited review, within 72 hours at the latest.
  • In emergencies, you may request an internal appeal and external review at the same time.
  • The federal external review process run by HHS is free. If a state process or independent organization is used, the fee may be no more than $25.
• The organization responsible for the external review is listed in the EOB or final denial letter.

• This federal law, in effect since January 1, 2022, protects people insured through an employer plan, HealthCare.gov, a state marketplace, or another individual plan from unexpected out-of-network bills in these situations:
  • emergency department visits
  • non-emergency care from an out-of-network doctor at an in-network hospital, hospital outpatient department, or ambulatory surgical center, such as an out-of-network anesthesiologist
  • air ambulance services
• In these situations, you cannot be charged more than your in-network cost-sharing amount, including your deductible, coinsurance, and copayment.
• Notice and consent form: if you sign it, you waive your protections. This form cannot be requested in an emergency department. It also cannot be requested for services such as anesthesia, pathology, radiology, neonatal care, assistant surgeons, hospitalists, and intensive care specialists.
  • The form must be provided in the 15 most commonly spoken languages; an interpreter must be provided if you speak another language.
• If your doctor leaves the network: if you are being treated for a serious and complex condition, receiving inpatient or institutional care, have a required non-elective surgery scheduled, are receiving treatment because of pregnancy, or have a terminal illness, you may continue seeing the same doctor at the in-network rate for up to 90 days.
• A bill received because you have not met your deductible is not a violation of this law.

• If you do not have insurance or do not use your insurance, a provider generally must give you a written Good Faith Estimate when you schedule an appointment at least 3 business days in advance or request one. You do not have to use the phrase “Good Faith.”
• The estimate is separate for each provider. For example, for surgery, ask both the surgeon and the hospital for separate estimates.
• An estimate is not provided for emergency care.
• Patient-Provider Dispute Resolution: you may dispute a bill from a single provider if it is at least $400 higher than that provider’s estimate. Conditions include:
  • you received the care uninsured or without using your insurance and told the provider this in advance
  • you received the care on or after January 1, 2022
  • you have a written Good Faith Estimate
  • the date of the initial bill is within the last 120 calendar days
• The dispute application has a nonrefundable fee of $25. If the decision is in your favor, this amount is deducted from what you owe the provider.
• While the dispute is pending, the provider cannot send the bill to collections, charge late fees, or penalize you. Your debt cannot increase regardless of the outcome.
• If you reach an agreement with the provider before the process ends, the provider must reduce the bill by at least $12.50.

• Tax-exempt (nonprofit) hospitals must have a written financial assistance policy (FAP) covering all emergency and medically necessary care. This assistance may provide free or discounted care.
• The hospital must publish the policy, application form, and plain-language summary online and make free paper copies available in the emergency department and registration area.
• If a language group exceeds 1,000 people or 5% of the population, whichever is smaller, in the hospital’s service area, the documents must be translated into that language.
• Deadlines:
  • You may apply for at least 240 days from the date of the first bill after discharge.
  • The hospital cannot begin “extraordinary collection actions,” such as selling the debt or reporting it to credit bureaus, within 120 days after the first bill.
  • It must provide written notice at least 30 days before beginning these actions.
• If you qualify for financial assistance, the hospital cannot charge you more than the amount generally billed (AGB) to insured patients.
• Once you qualify, the hospital must take reasonable steps to reverse collection actions it previously started, including removing negative information from your credit report.
• For-profit hospitals and other health care organizations may also offer financial assistance. Ask the billing department.

• If you cannot pay the bill, ask the provider whether you can get a payment plan or discount.
• Compare prices. Under the Hospital Price Transparency rule, hospitals must disclose their standard charges to the public. Search for “hospital price transparency” and the hospital’s name.
• Ask other nearby hospitals about the charges for the CPT codes on your bill and use this research in negotiations.
• Ask the hospital’s patient advocate for help. Many hospitals have one who can help you understand the bill and apply for financial assistance.
• If your state has a Consumer Assistance Program, you may get help with billing and insurance problems.

• If you applied for financial assistance, tell the debt collector and ask it to stop collection activity until the process is complete.
• If a collector contacts you about an unexpected out-of-network bill or you see such an entry on your credit report, you can file a complaint with the Consumer Financial Protection Bureau (CFPB).
• According to the CFPB’s 2023 statement, the three major credit bureaus removed paid medical debt and medical collection accounts under $500 from reports and wait one year before reporting medical debt. If you see such an entry on your report, you can dispute it with the credit bureau.
• Do not pay people or companies that promise to delete your medical debt from your credit report in exchange for an upfront fee.
• For additional consumer complaint options, see 12.8 Consumer rights.

• No Surprises Help Desk (CMS) — surprise bill questions, complaints, and appeal assistance
  • Phone: +1 800 985 3059
  • Hours: weekdays 08:00–20:00, weekends 10:00–18:00 (U.S. Eastern Time)
  • Help is available in more than 350 languages.
  • Web: complaint form · start a bill dispute
• HHS federal external review process (MAXIMUS Federal Services) — external review of insurance denials
  • Phone: +1 888 866 6205 (to request a form); fax: +1 888 866 6190
  • Address: MAXIMUS Federal Services, 3750 Monroe Avenue, Suite 705, Pittsford, NY 14534
  • Email: ferp@maximus.com
• Consumer Financial Protection Bureau (CFPB) — collection and credit report complaints
  • Phone: +1 855 411 2372
  • Web: CFPB complaint form
• Patient Advocate Foundation — a nonprofit organization referred by CMS that helps people with chronic or life-threatening illnesses access care and manage payments
  • Phone: +1 800 532 5274

• Paying the bill without comparing it with the EOB.
• Failing to appeal an insurance denial within 180 days.
• Signing an extended “notice and consent” form without reading it after being stabilized.
• Failing to request a written Good Faith Estimate before a planned uninsured service and failing to keep the estimate.
• Missing the 120-day deadline after the initial bill for a $400 dispute.
• Paying the debt by credit card without applying for financial assistance from a nonprofit hospital.
• Failing to note the person’s name, date, and reference number during phone calls.
• Paying services that claim they can remove your debt from your credit report.

• I am insured, but I received a bill from an out-of-network anesthesiologist. Do I have to pay it? For a procedure at an in-network hospital, if you did not sign a “notice and consent” form, you cannot be charged more than your in-network cost-sharing amount. You can complain to the No Surprises Help Desk at (+1 800 985 3059).
• I am uninsured, and my bill was $300 higher than the estimate. Can I dispute it? For the federal dispute process, the difference must be at least $400 on a single provider’s bill. You can still request a discount or payment plan from the provider and apply for financial assistance.
• Will my bill be sent to collections during the dispute? During a Good Faith Estimate dispute, the provider cannot send the bill to collections; if it is already in collections, the provider must stop collection activity.
• How long do I have to apply for hospital financial assistance? At nonprofit hospitals, you may apply for at least 240 days from the date of the first bill after discharge.
• My insurance denied my surgery as “not medically necessary.” What can I do? First file an internal appeal within 180 days. If the result is unfavorable, request an independent external review within 4 months. In emergencies, you can request both at the same time.
• Does external review cost money? The HHS federal process is free. If a state process or independent organization is used, the fee may be no more than $25.

• CMS – Find an action plan for your billing problem
• CMS – Good Faith Estimate example (PDF)
• CMS – Are you eligible for a $400 dispute: examples (PDF)
• CMS – Mail or fax dispute application form (PDF)
• CMS – Notice and consent form example (PDF)
• CMS – Your rights against surprise bills: sample notice (PDF)
• CMS – Sample Explanation of Benefits (EOB) (PDF)