A 9-Point Checklist for Challenging Hospital Overcharges
By Walther Kerr
September 16, 2025
A few weeks ago, I wrote about my family’s experience contesting a $22,603 surprise medical bill. My post on LinkedIn went viral, with more than 500,000 views. Hundreds of people contacted me to share their own medical billing horror stories.
Since then, I’ve worked with dozens of families fighting unfair medical bills. The same themes keep coming up. So that others may more effectively advocate for themselves, I’ve written the below guide as a checklist to fight unfair bills, drawing on the lessons I’ve so far learned.
To make the most of this guide you should:
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First, obtain your itemized bill and medical record from the hospital. If you have health insurance, it may also be helpful to have your explanation of benefits (EOB) documents, too. Most hospitals don’t readily provide these documents to patients unless the patient specifically requests them, typically by calling the hospital’s medical records department or using an online patient portal. Under HIPAA (Health Insurance Portability and Accountability Act), hospitals are legally obligated to provide these to you upon request within 30 days (with one possible 30-day extension).
Example of itemized medical bill
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Then, use this checklist to identify issues. This checklist is most relevant to patients contesting hospital bills or separate specialists bills stemming from a hospital visit (e.g. from surgeons, anesthesiologists, radiologists, etc.), but will be less helpful for insurance disputes (the subject of a future post). One annoying (and expensive) quirk of the American healthcare system is you may get multiple bills from different medical groups, in addition to the hospital, for the very same hospital visit.
- Finally, draft a dispute letter to send to the hospital. I’ve pasted a dispute letter template at the very end of this post.
A checklist: 9 ways to fight your medical bill.
With your itemized bill, medical records, and insurance EOB documents in hand, it’s time to get to work. Here are your nine checks to slash your hospital bill.
1. Check for undocumented services, i.e. “phantom” billing
Problem: Often medical bills include bills for “phantom” services that don’t appear in your medical record.
Example: One woman in Washington, DC contacted me about her case, where a medical group billed her more than $4,800 in charges for a surgeon’s time even though the surgeon did not appear in the medical record on the day of surgery. Another woman in California told me her medical bills included charges for an obstetrician who was not present on the day of procedure.
What to do: Starting with the most expensive charges on your itemized hospital bill, check to ensure that every single billed CPT code shows up somewhere in the medical record. If there’s a charge that’s not in the record, document that in your dispute letter.
2. Check for “upcodes,” i.e. charges for more complex services than were actually performed
Problem: Another common issue is “upcoding,” which refers to when hospitals bill you for more expensive services than what the medical record justifies. This can add thousands of dollars to your bill.
Example: One patient contacted me about his visit to a Connecticut hospital emergency room with routine stomach flu. The hospital billed it as a Level 5 Emergency Room visit (CPT code 99285) – the highest level often reserved for life-threatening cases requiring “high level medical decision making” – at approximately $4,500, even though the medical record showed the patient arrived with stable vital signs, perfect neurological function, and required only simple observation. The appropriate Level 3 code would have cost about $1,500, a $3,000 overcharge. I’ve seen other cases ranging from a 30-minute physician’s visit billed as a 60-minute appointment to charges for “open” surgery when the medical records showed that a less invasive arthroscopic surgery was performed (a $2,000 difference). In New York, a hospital used an “operating room” revenue code for stitching to mend a small cut, even though the the actual procedure was performed bedside in the ER, resulting in more than $11,000 in extra charges. Some hospitals may also add “modifier” codes, such as “modifier 20”, indicating that a service was more complex, but don’t justify why in the medical record.
What to do: Review your itemized bill, starting with the most expensive codes. Compare each billing code and revenue code against what’s documented in your medical records. Note any discrepancies.
Since medical billing codes are complex, AI tools can help decode them. After removing personal information from your medical records, try these prompts: “What are the official medical criteria for [CPT code]?” or “Based on this medical record excerpt, what billing code is appropriate: [paste medical record text].” You can also ask “Does this medical documentation justify [CPT code/Revenue code]]: [paste relevant parts of medical record/itemized bill].”
The AI responses can strengthen your dispute letter by showing exactly how the hospital’s coding doesn’t match established medical criteria. Just remember that AI tools have varying privacy protections, so you should consider removing names, dates, and account numbers before pasting any medical information. Also verify the AI outputs with Internet searches because its outputs are not always 100% accurate.
3. Check for double billing or “unbundled” charges
Problem: Hospitals often double bill for the same services, or charge for “unbundled” services. This is especially true with medicines and lab tests. According to industry guidelines and Centers for Medicare & Medicaid Services (CMS) regulations, when hospitals order lab panels, they are supposed to bill just a single time for all included tests and not “unbundle” the charges, i.e. bill the patient for each individual test.
Example: In one double billing case, a hospital billed a patient twice for the same surgery. In an “unbundling case,” a hospital charged a patient for each of the tests within the bundle, e.g. one charge for a creatinine test, another charge for a glucose test, etc., which drove up costs for the patient by hundreds of dollars per ordered panel. In fighting my own family’s medical bill (documented here), we were billed for fentanyl because the drug was ordered, however the medical record clearly indicated the drug was never administered.
What to do: Compare each charge against the medical record. Document any examples of double billing or “unbundling” in your dispute letter. Fighting some of these charges is straightforward. For example, it’s relatively easy to prove a hospital billed twice for the same surgical procedure.
However, for cases involving duplicate medicine charges, patients should examine the medicine administration record, which should be part of the medical record (and if it’s not in there, ask the hospital for it). If your medical record indicates that a physician ordered a drug but did not administer it, use that evidence to dispute your bill. Check to make sure the number of “units” ordered for a drug – e.g. one unit per hour of IV hydration – matches the medical record’s start and end times for that drug. Similarly if the medical record shows that a physician ordered a “panel” or “series” and you were instead billed individual charges for specific lab tests within that panel, you should also note that in your dispute letter.
4. Check if the hospital billed insurance correctly or sent your bill in a timely manner
Problem: Administrative errors can translate to high costs for patients, especially if the hospital did not file claims with insurers correctly or in a timely manner. This is because many insurance companies have their own coverage windows, and if a claim is submitted that falls outside the eligible submission window, insurers can deny coverage.
Example: In my own family’s case, when a collections agency contacted us about a $22,603 medical debt from two years ago, one of our first questions was, “Why didn’t our health insurer pay for this?” After requesting the hospital’s medical records we saw the hospital listed us as “uninsured” on their intake form, so they never filed with the insurer in the first place. I’m now working with another patient who was also sent to collections. In their case, the hospital waited more than 170 days to file the claim with the insurer. The insurer denied coverage.
What to do: Verify in the medical records, EOB, and your itemized bill that: a) the hospital actually sent your claim to the insurance company, and b) they did so in a timely manner. If the hospital waited more than 6 months to send you your first bill, you may also have grounds to contest the charges because some states have specific timely billing laws. Include any issues you find in your dispute letter.
5. Check if the hospital correctly obtained pre-authorization
The problem: After I posted on LinkedIn about our medical billing ordeal, one hospital insider reached out to share a common billing issue: hospitals failing to correctly obtain pre-authorization before providing services, then passing on massive bills to patients when insurance inevitably denies coverage. As he explained, pre-authorization is commonly required for MRI/CT scans ($1,000-$5,000), non-emergency surgeries ($10,000-$50,000+), specialist visits, and certain medications. When hospitals fail to get these approvals, insurance companies deny payment. Hospitals should absorb this cost, not you. This is because the contract requiring pre-authorization exists between the provider (hospital or medical office) and insurer.
Example: According to this insider, hospitals frequently submit sloppy pre-authorization requests or fail to file them at all. They might use wrong procedure codes, misspell patient names, or transpose policy numbers, for example. Sometimes they schedule procedures before attempting to get approval. When insurance companies deny these requests, many hospitals pass the bill on to patients.
What to do: Your insurance EOB document may often reveal the issue, stating something like “prior authorization required” or “no authorization on file.” If you see that, request…
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