Use AI to Object to a Hospital Bill
Case #8 - Actionable Steps to Challenge Ridiculous Hospital Charges
Hospital bills are notorious for being complex and ridiculously high. Many patients are dismayed to discover that the amount billed for their care is several times greater than what insurance companies pay for the same services. This disparity can leave uninsured or underinsured patients facing financial hardship over bills that seem arbitrary and unfair. Fortunately, patients are not powerless. By understanding the billing process and using AI tools like Google Gemini and ChatGPT, you can challenge and reduce unreasonable hospital charges. This essay outlines a detailed, actionable approach to objecting to hospital bill prices, along with resources and websites where you can find help.
1. Understand Your Hospital Bill
The first step in disputing a hospital bill is to review it thoroughly. Hospital bills are often complicated, listing obscure codes and charges. You may have received only a summary. Request an itemized bill that will break down each service, medication, and medical supply you were charged for with every Current Procedural Terminology (CPT) code number. This terminology is universal and will allow you to spot errors and questionable charges. Sometimes the HCPCS code is used, but the CPT code will automatically convert.
Tip: Compare each line item to your memory of the care you received. Look for duplicate charges, services not rendered, or items that seem unfamiliar.
Tip: Use the descriptions of the CPT codes as they may be cleared than hospital jargon
2. Check for Billing Errors
Billing mistakes are common in healthcare. If you have a friend or family member that is a healthcare professional, they might help you spot problems. Highlight them and note your questions. Carefully review your bill for:
Duplicate charges
Note codes that are similar. The CPTs will be the same or different by only the last digit.
Incorrect quantities (e.g., being charged for two X-rays when you only had one) –
Look for than one identical CPT code on the same day
Services you did not receive
Check the description of CPT codes on-line
Upcoding (billing for a more expensive service than what was provided)
Look at the description of the CPT code, not the hospital description, and see if this matches what was done.
Incorrect dates of service
3. Research Fair Pricing
To argue that your charges are unreasonable, you need evidence. Hospitals charge uninsured patients “chargemaster” rates that are far above negotiated by insurance companies as described in Hospital Markups Are Price Gouging. To determine what would be a fair price, research:
Medicare rates:
Medicare pays hospitals set rates for each service, which are publicly available at Physician’s Fee Schedule Lookup Tool You will discover these are much lower than the amount the hospital billed you.
Insurance allowed amounts:
My essay Hospital Markups Are Price Gouging describes exactly how to create tables using the information hospitals must provide on their website. You can easily use ChatGPT or Google Gemini to arrive at the numbers I calculated manually:
Download the hospital machine-readable pricing file.
In the ChatGPT or Gemini AI question box, simply ask for the value(s) you want, i.e. “What is the Average Insurance Payment for CPT Code 93005”
Upload the file using the “+” indicated in the AI question box.
With a table like Figure 1, you can argue you are being unfairly billed.
Online price comparison tools:
There are many websites to search for hospital pricing:
Chargemasterdb - This is an interesting site that shows national price comparisons for CPT codes. It was hard for me to believe that a hospital in Arizona actually charges $10,321 for an EKG. Sharing this with your elected state representatives might be an interesting approach.
Patient Rights Advocate Pricing Tool
4. Contact the Hospital Billing Department
Once you have your evidence, contact the hospital’s billing or patient financial services department. Be polite but firm. Explain your concerns, point out any errors, and present your research on fair prices. There is a sample letter at the end of this essay.
Ask about hospital uninsured discounts or financial assistance programs.
Request that your bill be adjusted to reflect the fair market rate or the median rate the hospital accepts from insurance companies.
Keep records of all communications, including the names and titles of people you speak with, dates, and summaries of conversations.
5. File a Formal Dispute or Appeal
If you are unable to resolve the issue informally, ask about the hospital’s formal dispute or appeal process. Most hospitals have a process for patients to challenge their bills. Submit a written dispute, including:
A clear description of the charges you are disputing
Supporting evidence (itemized bill, research on fair prices, etc.)
Copies of previous correspondence
Request a written response from the hospital.
6. Seek Assistance from Consumer Advocacy Groups
If your efforts with the hospital are unsuccessful, consider reaching out to consumer advocacy organizations. These groups can provide guidance, negotiate on your behalf, or help you file complaints with regulatory agencies. Some helpful resources include:
Patient Advocate Foundation – Offers case management and financial aid services.
Medical Billing Advocates of America – Professional advocates who can review your bill and negotiate reductions.
Consumer Financial Protection Bureau – Provides guidance on disputing medical bills.
National Consumer Law Center – Information on medical debt rights and resources.
7. File a Complaint with Regulatory Agencies
If you believe you are being treated unfairly or the hospital refuses to address your concerns, you can file complaints with:
Your state’s Department of Health
The state Attorney General’s office
Your state’s consumer protection agency
The federal Consumer Financial Protection Bureau (CFPB)
These agencies investigate billing practices and may be able to help resolve your dispute.
8. Negotiate a Payment Plan or Financial Assistance
If you are unable to get the charges reduced but still cannot afford the bill, ask about payment plans or financial assistance. Many hospitals have charity care programs or sliding scale payment options based on income. Do not be afraid to ask for help.
9. Consider Professional Help
If the above steps seem overwhelming, or if your bill is particularly large or complex, you might consider hiring a medical billing advocate or attorney. These professionals can review your bill, spot errors, and negotiate on your behalf, often for a percentage of the money they save you.
10. Be Persistent and Document Everything
Challenging a hospital bill can be a time-consuming process, but persistence is key. Always keep copies of all correspondence, bills, and notes from phone calls. Document every step you take. If the hospital sends your bill to collections while your dispute is ongoing, inform the collection agency in writing that the bill is in dispute.
Conclusion
Facing a large and unreasonable hospital bill can be daunting, but patients have options and rights. By carefully reviewing your bill, researching fair prices, communicating clearly with the hospital, and seeking help from advocacy groups and regulatory agencies, you can often reduce your financial burden. Remember, you are not alone—many organizations exist to help patients navigate the complex world of medical billing. Take action, stay organized, and don’t hesitate to seek support when you need it.
Opinion - Hospital Bills Cause Medical Errors
When a patient is subjected to a hospital bill that is 12 times higher than it should have been, they may accept a payment plan, such as $100 monthly. The patient in Case #8 would take years to pay off the bill unless it is adjusted as discussed. Hospitalization might take a decade or longer to pay off especially when a $54 EKG is billed at thousands of dollars.
If the patient already has a large outstanding balance at a hospital, they might be reluctant to seek care again when needed. They could refuse to have diagnostic tests or preventive services that their doctor might recommend for fear of financial ruin. Delay in care that could occur is another example of medical errors (1a, 1b, 2d & 3a) as discussed in Unsafe By Design: Why Medical Errors Remain a Leading Cause of Death.
Instead of charging the “chargemaster” rip-off fees, hospitals should be required by law to accept the median amount paid by insurance companies from cash paying patients. The next essay will show why hospitals are the leading cause of bankruptcy.
ADDENDUM
📄 Sample Letter: Hospital Bill Dispute Based on Unreasonable Charges
[Your Full Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Billing Department
[Hospital Name]
[Hospital Address]
[City, State, ZIP Code]
Subject: Dispute of Hospital Bill – Account #[Insert Account Number]
Dear Billing Department,
I am writing to formally dispute the charges listed on my hospital bill dated [Insert Date], totaling $[Insert Amount]. After reviewing the itemized statement, I believe the charges are unreasonably high and inconsistent with the rates typically reimbursed by insurance providers for the same services.
For example, [insert specific service or procedure] was billed at $[Insert Hospital Charge], whereas Medicare and private insurers routinely reimburse between $[Insert Range] for this service. This discrepancy raises serious concerns about the fairness and transparency of your pricing practices for uninsured or self-pay patients.
I respectfully request the following:
- A full itemized breakdown of all charges, including CPT codes and descriptions.
- A review and adjustment of the bill to reflect rates comparable to those accepted by major insurers.
- Information about any financial assistance or charity care programs I may qualify for.
I am committed to resolving this matter in good faith and am open to discussing a reasonable payment plan based on adjusted charges. Please respond within 30 days of this letter to avoid escalation to formal dispute resolution or regulatory review.
Thank you for your attention to this matter. I look forward to your prompt response.
Sincerely,
[Your Full Name]