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Email templates · Hospital and clinic

Email to ask a hospital to explain the codes on a medical bill

You asked for an itemized bill and got one, and it is a page of codes and abbreviations with dollar amounts next to them. Every line on a hospital bill carries a code. CPT codes are five digits and describe a procedure or service; ICD-10 codes are letters and numbers and describe a diagnosis; revenue codes are four digits and say which hospital department billed the line. Some of these lines may be things you never received, or the same thing billed twice, and you cannot spot that until you know what each code means. Asking in writing makes the hospital put a plain description next to each line, and that list is what you will use to dispute anything wrong.

Before you send

  • The itemized bill itself, not the summary statement. If you only have the summary, ask for the itemized version first; the hospital must provide it on request.
  • Your own account of the visit: when you arrived, what was done, what medications you were given and roughly how long you were there. Write it down now while you remember.
  • The explanation of benefits from your insurer, if you have insurance. It's the document that shows what the insurer paid and why. Lines the insurer denied are worth a second look.
  • A list of the specific lines you don't understand or that look wrong, by line number and code. A focused question gets a focused answer.
  • Know that a facility fee is a separate charge for using the hospital's space and staff, billed on top of the doctor's fee. It's common and often legitimate, but it should be explained like any other line.
Subject Plain-language explanation of charges, account [account number] 
Hi [hospital name] billing team,

I've received the itemized bill for account [account number], for [patient name], dated [date of service]. Before I pay, I'd like to understand what each line is for.

Could you send me a version of the bill, or a list, that gives a plain description for every code and charge? In particular, I'd like to understand:

- [Line number, code and amount, for example line 4, CPT 36415, $42]
- [Line number, code and amount]
- [Line number, code and amount]

I'd also like you to confirm that each charge matches the care I actually received on that date. My understanding of the visit is [one or two lines of what was done, for example an ER visit for a cut on my hand, with stitches and no imaging]. If any line was billed in error or billed twice, please correct it and send a revised bill.

Please hold the account from further collection while this is reviewed. I'm happy to pay what's correct once I have the list.

Thank you,
[Your name]
[Phone number]
[Date of birth of the patient]

Everything in brackets is yours to fill in. Keep the rest as it is or change the tone to match how you write.

After you send

  • A good reply is a line-by-line list with descriptions, sometimes called a detailed statement, often followed by a call from a billing representative. Go through it against your own account of the visit.
  • A bad reply is a new copy of the same bill with no explanations. Reply once, quote the specific codes again, and ask for a written description of each. If that fails, ask for the patient advocate or the patient financial services manager.
  • Duplicates, charges for medications you didn't get, and a "level" of visit that seems higher than what happened are the common errors. Dispute those specifically, in writing, with the line numbers.
  • If the hospital insists every line is correct and you still disagree, your insurer can request a review on your behalf, and your state's attorney general's office takes consumer billing complaints.

Or don't send it yourself

Forward the job to myagent@standinfor.me and let StandIn run the whole thread.

StandIn is an email assistant that handles conversations with businesses for you. You write it one email saying what you need. It writes to the business, waits for the answer, follows up when they go quiet, pushes back on the number when it should, and brings the results back to your inbox for you to decide. You don't need to install an app or sign up. The first email you send is already the start of the task.

Hand this to StandIn opens an email to myagent@standinfor.me with the job already written out

To myagent@standinfor.me Subject Get my hospital bill explained line by line 
Hi StandIn,

Please get the hospital to explain every code on my itemized bill in plain language and confirm the charges match the care I received.

The hospital and account: [hospital name, billing contact, account number].
Patient and date of service: [patient name, date].
The bill: [attach the itemized bill or list the lines and codes].
What actually happened at the visit: [short account of the care, in my words].
Lines that look wrong to me: [line numbers, or "none yet, I can't read the codes"].

Once you have the explanations, compare them with my account of the visit, flag anything billed twice or not received, ask the hospital to correct it, and bring me the revised bill.

Thanks,
[Your name]

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