How to get and check an itemized medical bill

What is an itemized medical bill?

The Centers for Medicare and Medicaid Services (CMS) is the federal agency that runs Medicare and Medicaid. It describes an itemized bill as a list of the costs for each item or service you are billed for. A plain statement may show only one total at the bottom. An itemized bill shows what makes up that total.

An itemized bill works a lot like a grocery receipt. A receipt that says "groceries, $82" tells you very little. A receipt that lists each product and price lets you spot a carton of eggs you never bought.

A hospital stay can have dozens of lines on the itemized bill. The list can include the room, lab tests, medicines and supplies, plus the doctors' fees. Some doctors bill separately from the hospital, so you may get more than one bill for one visit.

How to ask for an itemized bill

Start with the billing department of the hospital, clinic or lab. The phone number is usually on your statement. You can also ask for it in writing, which gives you a record of when you asked.

1. Have your account number and the date of service ready.
2. Say that you would like a fully itemized bill, showing the date, a description and the price of each charge.
3. Ask for the billing codes as well, since a billing code is a short number that stands for a service and helps you check each line.
4. Ask how long it will take and how it will be sent to you, by mail or through an online account.
5. Write down the date, the name of the person you spoke to and what they said.

If you are already working on a payment plan or a discount, ask for the itemized bill first. It is easier to fix a mistake before the amount is agreed than after. Keep every copy, and mark any line that raises a question so you can find it during the call.

The federal health department says that a privacy law called HIPAA gives you the right to see your own records, including billing and payment records. Some states also have their own rules about itemized bills. Many offices send one when you ask, even where no state rule requires it.

If the office wants to charge a records fee, ask what it is before you agree. CMS notes that some providers charge a fee for copies of medical records.

What to look for on the bill

Set the itemized bill next to any papers you already have. These include the discharge papers from the hospital, notes from your visit, and an explanation of benefits (EOB). An EOB is a notice from your health plan that shows the costs of your care, and it is not a bill. CMS suggests the checks listed below as a good place to start.

• Look for a charge that is listed twice. Double billing is most common when you saw more than one provider.
• Check that every service on the bill is one you actually received. CMS says you should not be billed for a service that is not in your medical records.
• Read the description that goes with each billing code. If a description does not match the care you had, ask the billing office about it.
• Check the dates of service and the spelling of your name.
• If you have insurance, compare the bill with your EOB and confirm that the amount marked as your share matches.

Billing codes can look confusing, and descriptions are often short or full of medical terms. CMS says to contact your provider if you do not understand a listed item. A patient advocate, which is a person who helps patients with billing and care problems, may also be able to help.

Itemized bill versus summary bill

A summary bill gives a total and maybe a few headings. An itemized bill, by contrast, lists each charge on its own line. If you only have a summary, ask for the itemized version before you pay or set up a payment plan.

If you had no insurance, you may also have a good faith estimate. That is a written price estimate for the care you expected. CMS says you may be able to dispute a final bill that is $400 or more above the estimate. You have to start that dispute within 120 days of getting the first bill. Our good faith estimate guide explains how to dispute a bill like that.

The itemized bill is also the best starting point for a price talk. Once you can see each line, you can ask for a self-pay discount or a lower price on a charge that looks too high. Our negotiation guide has scripts you can use.

What to do if you find a mistake

Start by calling the billing department of the place that sent the bill. Name the line that looks wrong and say why, for example that the charge is listed twice or that the service was never given. Ask them to fix it and to send you a new bill.

If the office does not fix it, CMS lists other places to turn. Your health insurer can help sort out errors if you have a plan. Your state may have a Consumer Assistance Program that helps with billing problems. The federal No Surprises Help Desk at 1-800-985-3059 can also answer questions.

If the bill has already gone to a collector, you can ask the collector in writing for proof of the debt. Our guide on medical bills in collections shows how. You can also read about help with medical bills if the total is more than you can pay.

If you think you are having an emergency, call 911 or go to the nearest emergency room. Do not wait for a bill or a price. When you need a regular doctor at a clear price, use our directory.