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How to review a medical bill before you pay it
This is the manual first-pass workflow Clever Dispute is turning into an automatic tool. It does not replace legal, medical, or insurance advice — it helps you ask better questions and organize a dispute.
Quick rule
Do not start by arguing over the total balance. Start by getting the itemized bill, matching it to your EOB, and identifying the exact line items that need review.
1. Get the right bill before you review anything
- Ask the provider for an itemized bill, not just the balance due page.
- Ask for CPT/HCPCS codes, service dates, quantities, insurance adjustments, and the billing department contact.
- If the account is already in collections, ask whether the provider can pause collection activity while the bill is reviewed.
2. Match the bill against your EOB
- Find your insurance Explanation of Benefits for the same dates of service.
- Compare patient responsibility, deductible, copay, coinsurance, denied charges, and provider write-offs.
- Flag anything the provider says you owe that the EOB shows as adjusted, denied for provider responsibility, or already paid.
3. Check for common billing errors
- Duplicate charges for the same date, code, or service.
- Wrong quantity, especially supplies, injections, therapy units, anesthesia time, or lab panels.
- Services you did not receive or services billed on the wrong date.
- Bundled services billed separately when they may be included in another charge.
- Facility fees or out-of-network charges that were not clearly disclosed before care.
4. Ask for the documents that prove the charge
- For procedure charges: ask for the operative report or procedure note.
- For emergency/outpatient bills: ask for visit notes and charge detail records.
- For insurance denials: ask the insurer for the specific denial reason and appeal deadline.
- For high balances: ask for the hospital financial assistance policy and application.
5. Send a simple dispute letter
- Include your name, account number, dates of service, and the charges you dispute.
- Say exactly what you want reviewed: coding review, duplicate-charge review, insurance rebill, itemized correction, or financial assistance review.
- Attach the bill, EOB, notes, and any proof you have. Keep a copy of everything.
- Send it to the provider billing department and, if insurance is involved, your insurer's appeal or member services address listed on the EOB/card.
Simple dispute-letter outline
Billing Department,
I am requesting a review of account [ACCOUNT NUMBER] for services on [DATE]. I am disputing the following charges: [LIST CHARGES/CODES].
Please provide the itemized bill, coding notes, and any documentation supporting these charges. I am requesting correction, rebilling to insurance, or written explanation for any charge that cannot be verified.
Please pause collection activity while this dispute is reviewed and send the response in writing.
Thank you,
[YOUR NAME]