Learn how to Write a Medical Invoice Dispute Letter (Template Included)


How usually do you see the physician? When you’re the typical American, this quantity is 4 instances a yr[1]. Every time you go to the physician, you’re handed a invoice, however have you ever ever questioned its accuracy? Understanding tips on how to write a medical invoice dispute letter may be essential in these conditions.

Some research recommend that 8 in 10 medical payments are incorrect[2]. That is the place the medical dispute course of is available in. By writing a medical invoice dispute letter, you may establish these errors and keep away from being unnecessarily overcharged for medical companies.

Whether or not the invoice is for an annual checkup or a hospital keep, we’ll discover some methods to craft the best medical dispute letter.

Women writing a Medical Bill Dispute Letter

What Is a Medical Invoice Dispute Letter?

This can be a sort of letter that you simply write to the hospital or physician’s workplace to dispute what you have got been charged. As an illustration, in the event you see you had been charged for 2 X-rays however solely obtained one, you can write a letter to dispute this.

This letter is just to dispute costs with the medical service supplier, to not dispute your insurance coverage protection.

You may also write a medical dispute letter to dispute the price of companies in the event you can show the greenback whole is unreasonable. Nevertheless, in case you are searching for a reduction or just can’t afford the invoice, writing a medical invoice negotiation letter can be a greater resolution.

✍️ Be taught extra: For these navigating healthcare prices, understanding tips on how to craft a medical invoice negotiation letter may be invaluable.

High Causes for Writing a Medical Dispute Letter

There are two predominant causes for disputing medical payments: errors and overcharging. For the most effective outcomes, you’ll wish to craft your letter across the cause in your dispute.

1. Billing Errors

It’s essential to do not forget that docs and hospital workers are simply people who’re able to making errors. That outrageous medical invoice you obtained might be not malicious. It could simply be the results of a clerical error.

The most typical kinds of billing errors embody:

  • Duplicate costs
  • Coding errors, together with upcoding
  • Mistaken id (i.e., they charged you rather than one other affected person with an analogous identify)
  • Canceled procedures
  • Bundled vs. unbundled pricing (i.e., receiving a reduction for the complete process)

Estimates on how steadily medical payments include errors vary from a conservative 30% as much as a whopping 90%. These errors hit $68 billion yearly only for hospital billing errors[3].

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2. Unreasonable Pricing

Generally, all the fees in your medical invoice are correct, however the remaining whole remains to be outrageous. If that is so, you may provoke a dispute based mostly on unreasonable pricing.

To confirm that the fees are, in truth, extreme, you’ll wish to collect proof. When you have a earlier invoice for comparable companies that had been a lot decrease, you should use this as proof of unreasonable costs.

One other good supply of proof could be an estimate of the invoice in your companies from both this supplier or different native suppliers. As an illustration, in the event you in contrast the costs provided by a number of different suppliers they usually all got here in with decrease totals, you can use this as proof of unreasonable pricing.

When you don’t have earlier payments and/or can’t get estimates from comparable suppliers, you may take a look at the Clear Well being Prices web site for steerage on what costs are cheap versus unreasonable.

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What to Do Earlier than Writing a Medical Invoice Dispute Letter

Earlier than writing up your dispute letter, there are just a few items of data you’ll wish to collect.

The primary and most essential could be acquiring an itemized copy of your invoice. Medical payments are sometimes prolonged and complex, so that you’ll have to undergo the invoice line by line to establish any errors.

Gathering insurance coverage documentation also can assist together with your dispute. In case your EOB (rationalization of advantages) comes up with a distinct whole than your medical supplier, this might be an indication of potential billing errors.

As a remaining step, you’ll wish to collect info out of your supplier on what must be within the letter. Issues like affected person identification numbers, billing numbers, who the letter must be addressed/despatched to, and many others.

⚠️ Warning: Whereas gathering all wanted info and paperwork is important, don’t delay writing your dispute letter too lengthy. Many hospitals and physician’s places of work have a restricted dispute window (i.e., 30 days).

Pattern Medical Invoice Dispute Letter

Your Identify
Your Handle
Metropolis, State, Zip
At this time’s Date
Hospital or Physician’s Identify
Billing Division (optionally available)
Hospital or Physician’s Handle
Metropolis, State, Zip 
Account or Billing ID Quantity

To Whom It Might Concern:

This letter is to formally inform you that I’m disputing costs on the invoice [bill number here, or date if there isn’t a number]. This invoice issues [describe service here] carried out on [date/date range]. I’m disputing [bill line item] cost for [charge amount] as a result of [reason for the dispute].

I’ve included [dispute proof] exhibiting [add details]. I’ve additionally included [add details for any additional evidence you provide]. As you may see, from the data I’ve included, [restate what you are disputing and why].

I wish to request that you simply ship me a revised invoice the place [charge being disputed] is eliminated (or adjusted). I hope to listen to from you as quickly as potential upon receiving this letter. Please contact me at [phone number] or [email address].

Thanks in your fast consideration to this matter.

Your Signature
Printed Identify
Account or Billing ID Quantity
Listing of Enclosures (optionally available)

Learn how to Write an Efficient Medical Invoice Dispute Letter

The above letter is only a pattern. Your medical invoice dispute letter must be custom-made to your distinctive state of affairs. It must also be well mannered {and professional}.

Listed here are the important thing elements that your dispute letter ought to include.

Man Writes Effective Medical Bill Dispute Letter

Billing/Affected person Information

This data ought to be included in an easy-to-read part above the letter physique, and it may be repeated in your letter’s introduction in addition to your signature.

Embrace any info to assist establish you and the invoice(s) in query. As an illustration, in case your hospital/physician’s workplace assigns affected person IDs or distinctive billing numbers, embody this info.

Different affected person and billing data, akin to date of delivery, invoice whole, service date, and many others., may also be included.

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Description of Dispute

Your letter intro ought to deal with what you might be disputing and why. If you’re disputing billing errors, record which objects in your invoice are incorrect and what sort of error is concerned (i.e., duplicate cost).

As an illustration, “I’m disputing the 2nd chest X-ray cost as a result of it’s a duplicate cost.”

If you’re disputing based mostly on unreasonable pricing, you’ll wish to state upfront why you imagine the fees are unreasonable. As an illustration, “I’m disputing the MRI cost as a result of the overall was $800 greater than the unique estimate.”

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Proof of Dispute

When you’ve outlined what you might be disputing and why, you’ll want to supply proof to assist your declare.

You possibly can reference the medical invoice for particular errors, like duplicate costs. I.E., I’ve included a highlighted copy of the itemized invoice exhibiting the duplicate costs.

Different errors might require further proof. As an illustration, in instances of mistaken id, you might have to show who you might be and supply proof that you simply didn’t obtain the medical companies charged.

For pricing-based disputes, you may cite any authentic estimate you obtained, prior payments for a similar service, or a web site like Process Worth Lookup. I.E., “I’ve included the estimate from XYZ supplier exhibiting {that a} value of $500 for this service could be truthful.

Request for Contact

The final little bit of your medical invoice dispute letter ought to embody a request for a revised invoice and directions on the way you want to be contacted. As an illustration, “I wish to request that you simply ship me a revised invoice the place the MRI cost is appropriately adjusted.”

You may also embody a timeframe in your medical invoice dispute letter for whenever you wish to be contacted, i.e., 30 days. Simply bear in mind to be well mannered and set an inexpensive timeframe.

What to Do As soon as You Have Despatched the Letter

When you’ve despatched the letter, you’ll wish to comply with as much as confirm that the letter was obtained. Even in the event you despatched the letter by licensed mail, you’ll nonetheless wish to double-check.

In case your letter has been obtained and an investigation opened, you’ll wish to know what this implies. Is the due date on maintain? Are you able to proceed receiving companies from this supplier? How lengthy will it’s earlier than they decide?

You’ll wish to hold a document of all communication; this may embody saving copies of emails in addition to noting down the time and date of cellphone calls and who you spoke with.

Simply bear in mind the dispute and investigation course of can take time. Frequent contact is OK, however calling or emailing every day possible received’t accomplish a lot.

What to Do When Your Dispute Is Accepted

Congrats, the hospital or physician’s workplace has agreed with you and authorised your dispute. In the event that they haven’t already offered it, request a revised copy of the itemized invoice exhibiting your new whole.

Save any communication you obtain in the course of the dispute course of to make sure the inaccurate invoice isn’t charged towards you once more later.

What to Do When Your Dispute Is Rejected

If the hospital or physician’s workplace outright rejects your dispute or is just unresponsive, there are further steps you may take.

When you have proof of an precise billing error, it might be time to escalate the problem to a supervisor, contact a affected person advocate, or submit a grievance to state regulators. Talking with an legal professional can be a last-resort choice.

When the dispute was as a consequence of unreasonable pricing, you can attempt an alternate route. Particularly, the No Surprises Act gives a dispute course of when your costs are $400 or extra over the unique estimate.

When you didn’t obtain an estimate, and the supplier received’t budge on their pricing, it might be time to pursue different choices for negotiating your medical invoice.

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