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Ultimate Guide To Disputing A Medical Bill And Reducing Your Payment


Disputing A Medical Bill

Over the last few years, I’ve encountered several major issues with medical billing. It’s made me quickly understand how to dispute your medical bill, get errors corrected, and reduce your payment.

First, I was incorrectly billed for the wrong procedure – one that cost almost 10x more than the one I had. Second, I had a procedure done at one location, and again at a second location, with the second location charging almost double the first.

The fact is, I don’t “use” a lot of medicine. If these errors happen with this frequency – looking at my bill history, I put the error rate at roughly 2% – it’s likely impacting others as well.

I wanted to put this ultimate guide for disputing a medical bill together so that you know exactly what to do if you think your medical bill is outrageously prices or plain wrong. 

Table of Contents

My Medical Billing Issues
General Notes Before Disputing A Medical Bill
Step 1. Review Your Bill & Explanation Of Benefits
Step 2. Get A Detailed Line-Item Bill
Step 3. Call The Medical Provider Billing Department
Step 4. File An Appeal With Your Insurance Company
Step 5. File An Appeal With Your Medical Provider’s Patient Advocate
Step 6. Contact Your State Insurance Commissioner 
Step 7. Consider Legal Counsel 
Final Thoughts

My Medical Billing Issues

As I mentioned before, I had both an incorrect billing issue and an “outrageous” pricing medical billing issue. I as able to resolve both successfully, and I learned a lot along the way.

Here’s what happened to me:

The Broken Bone

In my first encounter with disputing a medical bill, I was charged for a surgery I never had! I had broken my ulna (wrist bone) and gone to urgent care. At urgent care, I got an x-ray, and they discovered it wasn’t a bad fracture. As such, they put me in a wrist brace and sling, gave me some pain meds, and said I would be fine but let it heal for 6 weeks.

No cast, no surgery, nothing major.

But when the bill came, it was for $8,500! How could my urgent care visit and x-ray cost $8,500 was beyond me.

In the end, I discovered that the medical billing code was 1 digit off – meaning they billed me for a broken ulna surgical repair (actual surgery to repair the bone) versus a broken ulna non-surgical consultation. One error in medical billing send the price from about $800 for the urgent care visit and x-ray to $8,500.

The Expensive CT Scan

I’ve had two CT scans in my life – and for some reason, one was double the price of the other. The first CT scan was at one office, and it ended up costing $600. My doctor booked my second appointment at another office (due to scheduling), and the bill for this one came back at $1,200. For the same thing!

In this case, there was no billing error – just outrageous pricing. After a few phone calls and discussions, asking the right questions, and talking to the supervisor, I was able to get the bill reduced by 50% – to the same cost as the other procedure. 

General Notes Before Disputing A Medical Bill

Before we dive in on the step-by-step way to dispute a medical bill, there are some general notes I want to cover first.

When disputing a bill, it’s important that you do your research and understand what happened and what’s going on. That way you can help troubleshoot the problem without passing blame. Customer service reps will be much happier to work with you if you adapt this approach.

Second, realize that mistakes will happen. Even if 99.999% of medical bills are done correctly, there will still be errors. People still process these. Be sympathetic up front to this. 

Third, take diligent notes of all your conversations and encounters throughout the process. You should record conversations if possible (and allowed), and get things in writing. At a minimum, I recommend:

  • Date and Time
  • Who you spoke to (first and last name, ID number if possible)
  • Details of the conversations
  • Commitments from the company/individual with specific timelines to follow up (i.e. When can I expect this to be resolved? When should I follow up if I don’t receive anything?)
  • If on a cell phone, screenshot your phone at the end of the conversation to highlight the phone number you called, and the length of time you were on the call. If you can’t do this, keep your phone statement with the call.

If you’re mailing documents or doing any written correspondence, I recommend:

  • Ensuring you keep a copy of everything you send, with date mailed
  • Send all mail certified mail with return receipt – put the return receipt with your copies of what you sent so you have proof they received it

Finally, when disputing a bill, it’s important that you ask about the due date of the bill. You want to ensure that collection on the bill is paused or suspended while the bill is being disputed. If they don’t do that, ask that the due date be extended out a period of time. This is especially important because medical bills can end up on your credit report and hurt your credit score.

The bottom line is you don’t want this company to send you to collections while you’re disputing their bill.

Step 1. Review Your Bill & Explanation Of Benefits

The first thing you get (typically before your medical bill even arrives) is your explanation of benefits from your insurance company. I would venture that 95% of people throw these away and don’t even know what they are for.

Next, your actual bill will come in the mail.

It’s so important that you review BOTH your medical bill AND explanation of benefits. This could be the first sign of something wrong.

First things first:

What Is An Explanation Of Benefits?

The Explanation of Benefits is a document provided by your insurance company the explains your insurance benefits as it pertains to a bill.

While every company lays out their Explanation of Benefits differently, you will usually see something like the following:

  • Amount Billed By Provider (this is how much the doctor or hospital charges)
  • Plan Discounts (this is a discount negotiated by your insurance company)
  • Amount paid by insurance company
  • Amount you will owe the provider

Most explanation of benefits forms will also include information about your deductible, co-pay, co-insurance, and more.

If a procedure is not covered, the explanation of benefits will also typically have a code or error, with a short explanation as to why it’s not covered. To get more information, you typically have to call.

Here’s an example:

Explanation Of Benefits | Source: The College Investor

How Does An Explanation Of Benefits Compare To Your Bill?

Now that you understand what the explanation of benefits it – you need to compare it to your bill. Your bill should exactly match the explanation of benefits. This could be your first sign of an error!

In some cases, I’ve seen medical bills that forget to apply the “plan discount” and so the patient is billed a higher amount than the Explanation of Benefits states. This is why it’s essential that you compare the two.

However, some companies may combine multiple bills into one. For example, I received the following bill for $192.00:

Medical Bill Example | Source: The College Investor

However, at first, I only saw this Explanation of Benefits:

Explanation of Benefits 2 | Source: The College Investor

As you can see – my Explanation of Benefits was $24 short of what they billed me. However, upon closer inspection, they combined two Explanation of Benefits into one bill (this EOB and the EOB from above for $24). The company clearly billed my insurance company two separate times, but only billed me once.

However, if you receive your EOB and your bill, and you believe something is wrong, you need to get a more detailed picture.

Step 2. Get A Detailed Line-Item Bill

Once you’ve gone over your Explanation of Benefits and Medical Bill and you believe there is a problem, you need to request a detailed line-item bill. You can typically do this by calling the medical billing department listed on your statement, or in some cases, you can go online and print it.

What you’re looking for is a detailed bill that lists out everything:

  • Date and Time
  • Medical Billing CPT Code
  • Description
  • Total Price
  • Insurance Adjustment 
  • Patient Amount Due

Here’s an example:

Medical Billing Detail | Source: The College Investor

As you can see, when you have a procedure done, you can have a LOT of billing codes for the same event. If you have a hospital stay, the list could be huge.

But it’s on this list that you’ll be able to spot any errors in billing. The CPT Billing Code is key. To review your bill, you want to search for the billing code listed on your detailed bill.

For example, CPT Code 85025 is a blood test to check white blood cell count and more. There are multiple websites that allow you to search CPT codes, but I’ve found search to work best. Especially because it will find discussions around these codes for medical billing issues.

In my case, it’s where I discovered I was billed for the wrong procedure. I was billed for Ulna Surgery, when I didn’t have a surgery, but just an examination. There was a 1 digit error in the code which resulted in a 10x medical bill.

However, just finding the error is only the start of your medical billing dispute.

Step 3. Call The Medical Provider Billing Department

Once you’ve figured out what the issue is, it’s time to start making some phone calls. The first stop is simply calling the medical billing department’s customer service line and talking to them.

I know this sounds crazy, but you have to start here. So many people want to jump to lawsuits, when they haven’t even started to address the problem with people who can potentially fix the issue

Depending on the issue (either incorrect billing or a price dispute), you will want to take one of two approaches.

In the case of an error, simply tell the representative that you’ve found an error and would like to dispute it. Ask what the process entails. 

Typically, the customer service agent will tell you:

  1. They will put in a request for their team to research the issue
  2. They will put your bill on hold while they research the issue
  3. They will give you some type of timeline to hear back on the request (typically 4-6 weeks)

Going back to the beginning of this article – make sure you document this in detail. Confirm with the agent what part of your bill is on hold – is it the total balance or just the disputed item. If it’s just the disputed item, you need to make sure you pay the rest of your bill on time.

If you’re simply calling to dispute a price or total amount of the bill, the customer service agent may be able to help you.

When I first called the billing department to dispute the price of the CT scan, I made it come across as this was a burden to pay double what I had previously paid. Without even skipping a beat, the agent on the phone said she could immediately reduce my bill by 20% if I made the full payment on the phone with her.

From doing my research on this article, this seems to be a fairly common practice with medical billing. In exchange for something immediately, most companies will offer a serious reduction in price. 

However, just like every call center and customer service center, medical billing departments have supervisors too. And if you can speak to a supervisor and explain your story a bit, you might have better luck securing a bigger discount on your medical bill.

For my story, I was able to get them to match the price of the procedure, effectively giving me a 50% reduction on my medical bill.

Step 4. File An Appeal With Your Insurance Company

If you’re covered and using your insurance to pay for a medical procedure (or at least part of it), a great way to make progress on disputing your medical bill is to also file an appeal with your insurance company.

This can really work in your favor if there is a medical billing error (like I had with the ulna surgery that never happened). You see, your insurance company doesn’t want to ever pay more money than they have to. If you discover an error, even if they’ve already paid it, they might be incentivized to go back to the medical provider to resolve it as well.

That helped me a lot in my case. My insurance company still had to pay more money than they should have when it came to my broken wrist. They opened a dispute on their end, after I had opened a dispute on my end.

If you were incorrectly billed for a procedure and not only are you having to pay a lot of extra money, but your insurance company is too, they will want to know about it. And, it could help you get the entire situation resolved.

Step 5. File An Appeal With Your Medical Provider’s Patient Advocate

Depending on your medical provider, they may have a patient advocate that could help you reduce your bill, help expedite resolution of errors, and more. Patient advocates are usually found in hospitals and large medical provider networks (like HMOs) that serve a lot of patients.

These people are exactly what they sound like – people who advocate on behalf of the patient. If you’re not getting resolution (or things are taking longer than promised) with the billing customer service department, getting a patient advocate involved can be very helpful. 

Patient advocates are also typically empowered to give discounts to bills as well. Even if it’s not error related, they could help in times of hardship. They also have great connections to resources that can also help you if you can’t afford your medical bills. 

Step 6. Contact Your State Insurance Commissioner 

The next step if you can’t find a resolution to your medical billing dispute is to loop in your state regulators. Insurance is handled at the state level by a State Insurance Commissioner. While laws vary from state to state, most states have departments that are willing to help consumers in their states navigate the complexities of health insurance.

When you contact your state insurance commissioner for disputing a medical bill, it’s essential that you have all of your paperwork and documentation in order. 

You will typically need to fill out an official complaint form, and you can then attach your own documentation to support. 

If there is a true medical billing error not being resolved, this is where you can clearly state the error, the CPT codes that were inaccurate, what the codes should have been, and the potential estimated difference in price.

If your claim is simply being denied by your health insurance, this is also the appropriate place to dispute that request. In some states (like California), there is a specific request for an Independent Medical Review to determine if you should be covered.

Step 7. Consider Legal Counsel 

Finally, the last step, if you’re still not getting resolution on your medical billing dispute is to seek legal counsel. You will want to find an attorney that specializes in medical billing disputes.

Most attorneys will do a free call to determine if they can even be of assistance to you and if you potentially have a case. They will also tell you what the costs might be. It could get expensive.

To find an attorney:

  • Contact your state bar association for a referral (many state bar associations have referral services)
  • Search for attorneys on a platform like Avvo, which has attorney profiles. Avvo also provides a record of client reviews and peer endorsements, which can be helpful in selecting an attorney.
  • Once you find an attorney you might want to work with, cross-reference the attorney with your state bar association to see if that attorney has any record of public discipline.
  • Do a Google Search of that attorney to see if their name comes up in a good way (for example, through press or publications) or in a bad way (such as being sued by a government agency or regulatory body for misconduct).

Final Thoughts

Disputing a medical bill and reducing your payment can be stressful and frustrating. Navigating a complex bureaucracy, having the threat of creditors coming after you if you don’t pay, and simply the time it takes to get anything done make this one of the most unpleasant experiences a consumer can face.

I wanted to share a few reminders though.

First, don’t worry about your doctor. In many cases, doctors don’t get involved in billing at all. They don’t know if you paid or didn’t pay. And they aren’t suffering from you not paying your bill. Realize that your doctor’s number one priority is simply your health.

Second, don’t worry about your credit report. These disputes take time (a lot of time). And in some cases, you might see your bill turned over to creditors or reported on your credit report. Luckily, the laws have been changing in consumers favor. Last year, new rules made it so that medical debt cannot be posted to a credit report until it’s at least 180 days past due. And if it is paid and/or resolved, it must be removed from the report.

So, if you’re disputing your medical bill, don’t let your medical provider hold your credit report over your head.

If you’ve successfully disputed your medical bill, or lowered your payment, we’d love to hear about it. Leave a comment and share your story below for others to know about!

Editor: Clint Proctor

Reviewed by: Chris Muller

The post Ultimate Guide To Disputing A Medical Bill And Reducing Your Payment appeared first on The College Investor.

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The Offer

Direct link to offer

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Our Verdict

Miles aren’t elite qualifying unfortunately. Might still be useful for anybody that highly values miles.

Hat tip to Parts_Unknown-

What You’re Not Being Told About AI in Medicine



You trust your phone to get directions, your car to drive itself, and your search engine to answer your questions, but when it comes to AI in medicine, is that level of trust justified?

Here’s the thing: AI tools like ChatGPT are creeping into healthcare in ways that may sound helpful, but without proper oversight, they could be dangerous.

Take a recent story, for example. A 60-year-old man in New York was hospitalized after following dietary advice from ChatGPT, resulting in a severe case of hyponatremia. The man trusted the AI’s suggestion of a low-sodium diet, which led to dangerously low sodium levels in his blood.

Now. This isn’t your regular oopsy daisy. There are lives involved, reminding us that AI, no matter how smart it seems, isn’t a replacement for professional medical advice. Let’s take a closer look at why we need to be cautious when using AI in medicine.


Disclaimer: While these are general suggestions, it’s important to conduct thorough research and due diligence when selecting AI tools. We do not endorse or promote any specific AI tools mentioned here. This article is for educational and informational purposes only. It is not intended to provide legal, financial, or clinical advice. Always comply with HIPAA and institutional policies. For any decisions that impact patient care or finances, consult a qualified professional.

The Illusion of AI as a Medical Expert

Here’s a trap we’ve all been tempted to fall into: trusting AI tools like ChatGPT as medical experts. It’s easy, right? They process massive amounts of data in seconds, so they must be reliable, right? Well… not exactly.

Look, AI pulls from a ton of sources, but not all data is equal. Some of it is outdated, wrong, or just plain misleading.

Think about it this way: it’s like Googling your symptoms and reading a bunch of random articles. You don’t know what’s trustworthy and what’s not. With AI, it’s even trickier because there’s no one there to say, “Hold on, that’s not right.”

Here’s the kicker: AI doesn’t understand context like you do. Sure, it can give you recommendations, but it doesn’t know the patient in front of you. It doesn’t know their history, their lifestyle, or what else might be going on in their life. That’s where your expertise comes in. You don’t just follow guidelines, you interpret, you connect the dots, and you make decisions based on the whole picture. AI? It’s still a step behind in that department.

A study by Mount Sinai found that AI chatbots can easily spread false medical info, putting patients at risk. So, while these tools can help, they’re far from perfect, and they definitely shouldn’t replace the judgment of a real-life doctor.

The Dangers of AI-Generated Misinformation

If you think it’s not that bad, here’s something to really think about: AI chatbots can be manipulated to spit out false health information. A study from Flinders University showed just how easy it is for AI to spread misinformation.

And if you’re thinking, “Well, I’d never trust AI over a doctor,” you’re not alone. But what happens when a patient does? They trust AI, and that misinformation can have real, harmful consequences.

And don’t get me started on the mental health space. Or managing chronic illnesses. Those areas are already tough enough because of the lack of clear, reliable info. When AI gives the wrong advice, it makes things worse, not better.

We’re living in a world where misinformation spreads faster than truth. And with AI, it’s not just a few people being misled by a viral post on social media. It’s millions of people who could trust AI recommendations blindly. AI doesn’t have the critical thinking skills to differentiate between good data and bad data. You know this. But the average patient doesn’t.

This isn’t just some small issue. It’s a massive public health risk. A study by Harvard Medical School and the University of South Australia found that AI can be programmed to mislead millions. And right now, we don’t have the proper safeguards to stop it. So we need to be careful about how we use AI in medicine, and how we let our patients use it.

Ethical and Practical Considerations in AI Integration

Let’s talk ethics, since AI in medicine isn’t just a tech issue; it’s also an ethical one. Now that we know how AI can help spread medical misinformation on a much larger, much faster scale. What do we now do about it? How do we make sure AI benefits patients and doesn’t put them at risk?

Well, the problem is… It’s not the AI itself. It’s how we’re using it. Are we really ready to trust machines with decisions that affect human lives? And if we are, what happens when things go wrong? Who’s responsible?

Some doctors are already using unsupervised AI in their practices, making clinical decisions with the help of these tools. AI is still unproven. Without proper validation, AI could be leading doctors down dangerous paths.

It may not have the full picture of a patient’s history, or it could miss key details. And that’s something we can’t afford to overlook.

Beyond just making decisions, AI brings up other big questions, like who owns the data and who’s responsible if it all goes wrong. AI is still new in healthcare, and we need to get ahead of the ethical issues. We can’t just dive in without thinking through the risks.


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Final Thoughts: Proceed with Caution

AI could definitely revolutionize healthcare, but just because a tool is advanced doesn’t mean it’s infallible. We’ve got to approach it with a healthy dose of skepticism and caution because patient safety and good medical practice will always trump convenience.

Here’s the bottom line: AI should complement, not replace, the expert judgment of medical professionals.

Now, if you’re considering AI in your practice, ask the right questions:

  • Who developed this AI tool, and what are their qualifications?
  • What data was used to train the AI, and is it representative of my patient population?
  • Has this AI tool been validated in clinical settings?
  • What are the potential risks or limitations associated with this AI tool?
  • How does this AI tool comply with ethical standards and regulations?

By getting clear on these, you can make better decisions about how AI fits into your practice and keep patient care at the forefront. So, let’s keep our heads in the game, stay vigilant, and always remember: AI isn’t perfect, and neither are we. But together, with the right tools and the right approach, we can still deliver excellent care.

If you want to learn more about AI and other cool AI tools, make sure to subscribe to our newsletter! We also have a free AI resource page where we share the latest tips, tricks, and news to help you make the most of technology.

To go deeper, check out PIMDCON 2025 — The Physician Real Estate & Entrepreneurship Conference. You’ll gain real-world strategies from doctors who are successfully integrating AI and business for massive results.

See you again next time! As always, make it happen.

Disclaimer: The information provided here is based on available public data and may not be entirely accurate or up-to-date. It’s recommended to contact the respective companies/individuals for detailed information on features, pricing, and availability. This article is for educational and informational purposes only. It is not intended to provide legal, financial, or clinical advice. Always comply with HIPAA and institutional policies. For any decisions that impact patient care or finances, consult a qualified professional.

IF YOU WANT MORE CONTENT LIKE THIS, MAKE SURE YOU SUBSCRIBE TO OUR NEWSLETTER TO GET UPDATES ON THE LATEST TRENDS FOR AI, TECH, AND SO MUCH MORE.

Peter Kim, MD is the founder of Passive Income MD, the creator of Passive Real Estate Academy, and offers weekly education through his Monday podcast, the Passive Income MD Podcast. Join our community at the Passive Income Doc Facebook Group.

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