How to ask for an itemized hospital bill, and what to check in it

Summary bill vs itemized bill

After a hospital stay or an outpatient procedure, the first statement you get is often a summary: a few category totals such as "pharmacy," "supplies" or "room and board," and one balance. An itemized bill lists each charge separately, with the date, a description, a code, the quantity and the price.

The itemized version is what lets you check the bill. CMS, the federal agency that runs Medicare, starts its checklist for finding billing errors with one step: ask the billing department for a detailed bill that lists every item and service.

Do you have a right to one?

It depends on your coverage and where you live.

• Medicare. Federal law (42 U.S.C. 1395b-7) lets a person with Medicare-covered care submit a written request to a doctor, hospital or supplier for an itemized statement. The provider must send it within 30 days of the request. The law sets a civil money penalty of up to $100 for each failure to do so. After you receive the statement, you have 90 days to ask Medicare to review it if you believe something was billed that you didn't receive, or another irregularity such as duplicate billing.

• Everyone else. There is no single federal rule covering every patient. Some states have their own laws, and many hospitals provide itemized bills on request as a matter of policy. Ask the billing office; if they decline, ask your state health department or insurance department what applies.

In practice, most hospitals will send one if you ask, and asking costs nothing.

How to ask

By phone

Call the number on your statement and say:

"I'd like a fully itemized bill for account [number], dates of service [dates], showing each charge with its date, description, billing code, quantity and price. Please also include the insurance payments and adjustments."

Ask how long it will take and how it will be sent. Note the date, the name of the person you spoke to and any reference number.

In writing

A written request leaves a record, and for Medicare patients it starts the 30-day clock. Send it through the patient portal, by email or by mail.

Re: Request for itemized statement · Account [number]

Please send me a fully itemized statement for the services provided to [patient name], dates of service [dates]. Please list each item and service with its date, description, billing code, units and charge, along with any insurance payments, adjustments and payments I made. Please send it to [address or email].

Ask for your records too

CMS also suggests comparing the bill with your medical records. You shouldn't be billed for anything that isn't documented. Some providers charge a fee for copies of records, so ask about it first.

What to check on the itemized bill

Go through it with a pen and mark each line.

1. Dates. Every charge should fall within your stay or visit. Check the admission and discharge dates; a charge for a full day on the day you left is worth asking about.

2. Duplicates. The same item, code and date listed twice. CMS says double billing is common, especially when more than one provider was involved.

3. Quantities. A "10" where you expect "1" is easy to miss and can multiply a charge.

4. Things you didn't get. A medication you refused, a test that was cancelled, a service from a department you never visited.

5. Supplies and medications. Hospitals often list each dose or item separately. Compare with your discharge papers.

6. Codes. CMS suggests searching each code with the words "medical billing code" and checking whether the description matches the care you had.

7. Insurance and adjustments. If you're insured, compare the bill with your explanation of benefits (EOB). The amount you owe on the bill should not be higher than the EOB's patient responsibility.

A sample, decoded

Sample itemized statement · Northgate Regional Hospital (synthetic)

06/03 · 0250 Pharmacy · Ondansetron 4 mg inj · Qty 1 · $58.00

06/03 · 0250 Pharmacy · Ondansetron 4 mg inj · Qty 1 · $58.00

06/04 · 0110 Room and board, private · Qty 2 · $4,800.00

Two identical medication lines on the same day may be two doses or a duplicate; ask which, and check the medication record. Two room-and-board days for a stay of 06/03 to 06/04 may be correct or may count the discharge day; ask how the hospital counts days.

What to do with what you find

Call the billing office first

Go through each flagged line and ask for an explanation. If they agree it's an error, ask for a corrected bill and, if you're insured, whether a corrected claim will go to your insurer.

Follow up in writing

List each line you dispute, why, and what you're asking for. Keep copies of everything.

Ask about financial assistance

Nonprofit hospitals that are tax-exempt must have a written financial assistance policy under IRS rules. The IRS says it must cover emergency and other medically necessary care, explain who is eligible and how to apply, and be posted on the hospital's website and available free on paper. The bill itself must include a notice about it. If cost is the problem, ask for the policy and an application; you can do this while you dispute specific charges.

Get outside help

CMS points to state Consumer Assistance Programs and patient advocates. If you're on Medicare and a charge looks wrong, you can also ask Medicare for a review of the itemized statement within 90 days, as described above.

What an itemized bill won't tell you

It shows what was charged, not whether the price was fair or whether your insurer should have paid. For coverage questions, read your EOB and your plan documents. If a charge was denied, the EOB or denial letter will give the reason and the appeal deadline.

Get help reading the itemized bill

When EasyToDecode launches, you'll be able to upload your itemized hospital bill and get each line explained in plain English, quoted from the page, with likely duplicates, odd quantities and missing insurance payments flagged, plus a list of questions for the billing office. See how it works or join the waitlist.