What to do if the billing office says no

A no from the billing office is often not the last step. This page is for after you have asked. It has a script for the next call, what to ask after eight common answers, and the usual next official step for your situation, with its deadline rule, where to go and its source. If you have not asked yet, start with how to question or dispute a medical bill, or put your questions in writing with our free medical bill dispute letter.

For what surveys found when people questioned a bill, see how common medical billing errors are. This is general information, not legal advice, and nobody can promise the result. Whether to pay while you ask is your decision.

Before you call again

If the problem is paying rather than the charges, how to lower a hospital bill, or what to do if you can’t pay has the questions in order.

Have ready: the account number and the statement date from the bill, the first date of service, your insurer's Explanation of Benefits (EOB) if you have insurance, and something to write on.

If the bill arrived long after the visit, also ask when the claim was first sent; our guide on a medical bill that comes months later explains why.

Before you hang up, ask for these four things:

1. “Can you note on my account that these charges are under review, and hold it from collections while you look?”
2. “When can I expect an answer, and can you send it in writing, by letter, email or the portal?”
3. “If anything changes, can you send me a corrected statement before I pay?”
4. “Do you have a financial assistance policy? Please send it with the application.”

To close, say back what they told you: “So you will [what they said] by [date]. Your name is [name] and the reference is [number]. Thank you.” Write it down with the date and the time.

If they say...

Each answer below comes with what you can ask next, and the rule behind it where there is one. Each next step is a question, or a request for something in writing.

“The charge is correct.”

Ask: “Can you tell me what this charge covers, and send me that in writing?” Then: “Can you send the itemized bill for this line, with the code, date and units?” If you have insurance: “Has my insurer processed this line, and what did it allow?”

The Consumer Financial Protection Bureau suggests making sure the bill is calculated right and that you owe it before you pay, using your policy documents and your EOB (CFPB).

“Talk to your insurer.”

Ask: “On what date did you send the claim, and what is the claim number? Was it paid or denied, and why?” Then: “Can you hold the account while I check with my insurer?”

If your plan denied the claim, our free claim file letter asks it for the documents behind its decision. It asks for documents; it does not appeal.

With Medicaid, a provider taking part in Medicaid accepts Medicaid's payment, plus any deductible, coinsurance or copay Medicaid sets for you, as payment in full (42 CFR 447.15). Federal law does not allow Medicare providers to bill people in the Qualified Medicare Beneficiary (QMB) program for Medicare deductibles, coinsurance or copays (CMS).

“Pay first and we’ll review it.”

Ask: “Before I pay, can you note on my account that these charges are under review, and tell me in writing when it would go to collections?” Then: “Do you have a financial assistance policy?” and “Do you offer an interest-free payment plan?” State rules on interest and late fees are in our guide on interest and late fees on a medical bill.

Asking costs nothing, and some federal rules apply. If you had no insurance or paid yourself and use the federal patient-provider dispute, the provider must not move the disputed bill into collection, or threaten to, while the dispute is open (45 CFR 149.620, paragraph (c)(5)). A nonprofit hospital waits at least 120 days after the first bill sent after you leave before extraordinary collection actions (26 CFR 1.501(r)-6, paragraph (c)(3)). The CFPB suggests asking whether the provider will accept an interest-free repayment plan.

“We can’t give you an itemized bill.”

Ask: “Who should I send a written request for my billing records to, and when can I expect them?”

Billing records are part of the records you may ask a provider for. It answers within 30 days, with one extension of 30 days if it tells you why in writing, and may charge only a reasonable, cost-based fee for a copy (45 CFR 164.524). With Original Medicare, the provider sends an itemized statement within 30 days of a written request (42 U.S.C. 1395b-7). Our free itemized bill letter writes the request.

“It has been sent to collections.”

Ask: “Which agency has it, and since what date? Do you still own the account, or was it sold?” Then: “If I apply for financial assistance, can the account come back to you?” If a claim is still open, see sent to collections while insurance is still processing.

If a nonprofit hospital finds you eligible after a complete application within the application period, the federal rule has it refund what you paid above the amount you owe as an eligible patient (unless the difference is under $5), and take reasonably available steps to reverse most collection actions (26 CFR 1.501(r)-6, paragraph (c)(6)). Our guide on hospital financial assistance after paying has more on collections. For what to write to the agency, see if the bill is already with a collection agency, or fill in our free letter to a collection agency: it disputes the debt or asks the agency for verification, and says only what you tick.

“We don’t have financial assistance” or “You don’t qualify.”

Ask: “Can you send me the policy, or the decision and its reason, in writing?”

Nonprofit hospitals must have a written financial assistance policy (IRS). After a complete application, a nonprofit hospital tells you its decision in writing, with the reason for it (26 CFR 1.501(r)-6, paragraph (c)(6)). If you applied and were turned down, see financial assistance denied: how to appeal or reapply. Our free financial assistance letter asks for the policy and the form, and the charity care guide has the state rules we checked.

“We’ll keep the credit on your account.”

Ask: “Can you refund the credit balance instead, and how do I ask in writing?”

Some states set a deadline for refunding a patient's overpayment: see patient refund laws by state. Our free refund request letter asks in writing.

“You’re out of network, you owe the difference.”

Ask: “Was this processed under the No Surprises Act protections?”

If you have a plan through a job or an individual plan, for emergency care an out-of-network hospital or provider may not bill you more than your in-network cost-sharing (45 CFR 149.410). This does not cover people with no insurance, Medicare or Medicaid. The No Surprises Help Desk, 1-800-985-3059, answers questions about these protections (CMS). Our guide to the No Surprises Act says when they apply.