How to Fight a Medical Bill and Win

If you’re in the middle of a financial battle with a medical provider, you don’t want to miss this step-by-step guide on how to dispute a medical bill. I share proven tips based on my experience of fighting an out-of-network anesthesiology bill for almost two years!

This post may contain affiliate links. Read my full disclosure policy here.

Last year I was slapped with a HUGE medical bill and it was so unfair. I decided to fight it and followed this step-by-step guide to disputing medical expenses and guess what? It absolutely worked!! If you have a medical bill or even medical debt I highly recommend you try this process! #medicalbill #medicalbills #unfairmedicalbill

Have you ever received a medical bill you weren’t expecting? Or discovered that the amount you owed was a whole lot higher than it should have been? Not only is it frustrating to open that kind of mail in the first place, it’s exhausting to play phone tag between the doctor’s office and insurance agency trying to get it resolved!

And honestly, you wish you didn’t have to speak to nine different people before you found someone that could actually do something.

Believe me, I get it.

I’ve been fighting a medical bill for almost two years now, and I can’t even begin to tell you how hard it is to choose between ruining your credit score, or giving in {and paying a bill} that your insurance should have covered in the first place.

You see, in June of 2015, I had to undergo outpatient surgery at a local hospital. It wasn’t anything major, and it wasn’t an emergency. However, the surgery and the recovery were nothing compared to the paperwork battle that ensued nearly a year later.

Because in early 2016, I received an unexpected bill from the anesthesiologist for nearly $900. As it turns out, even though the surgeon and the hospital were in my insurance network, the anesthesiologist was not!! Over the next full year, I went back and forth with my insurance company, health provider, and the Florida Insurance commissioner before I was finally able to get everything resolved.

And in the end? Well, I didn’t owe much more than a small co-pay.

So even if you feel like giving up, or think it would be easier to just accept and pay “your portion” of the bill….don’t. At least not yet. Because I want to share just a few tips I learned along the way that will give you the courage to try again.

Warning: This post is long, but if you’re in the middle of a financial battle with a medical provider, you’ll want to take notes!

1. Do Your Research Ahead of Time

Medical messes are often avoided with a little bit of research before the procedure. Now, don’t get me wrong, I didn’t go into this outpatient service without doing any research. I made sure the hospital ran an insurance check as well as the surgeon.

But here’s where things went wrong. When I had the hospital check to see if my procedure would be covered, I assumed that they would be checking all aspects of the surgery. Turns out, that was not the case. They left out one minor detail. The anesthesiologist.

So when I went under the knife, I had an in-network doctor {that I had chosen}, an in-network hospital {that I had picked}, and an out-of-network anesthesiologist that was picked for me and had never met until he was putting drugs in my IV.

Over the last year I have discovered that this is not an uncommon practice. Many hospitals will contract with one specific radiology or anesthesiology office, and they are not required to check to see if those services will be covered by your insurance.

This means that it is up to you, the patient, to do your research ahead of time. If you are going to be having anesthesia, or any radiology work, check before hand to see if your insurance will cover it. Or if you want to be safe, don’t let anyone touch you without verifying through your insurance first. 

And yes, I totally get how annoying that is.

2. Call Everyone…A Lot

As I said earlier, I didn’t get this bill until nearly a year after my surgery. I paid my hospital. I paid my surgeon, but suddenly I had a $900 bill sitting on my desk from the anesthesiologist. Even though I could have wiped out my emergency fund to pay the bill, I was frustrated that my rather expensive insurance wasn’t stepping up to the plate.

So I called. {Or… more accurately, I made my husband call. 🙂 }

  • He called the anesthesiologist office and asked them to explain the charges. He also asked for the bill to be reduced or removed since I was unaware prior to the procedure that I would not be covered. They said no. {Obviously}.
  • He called my insurance company and asked them to cover the charge since my procedure was done at an in-network hospital with an in-network surgeon. {Another no-go.}
  • He called the hospital out of frustration that they would even allow something like this to happen in the first place. {Didn’t really get anywhere}.
  • He called the anesthesiologist again. {Nada}
  • He called the insurance company again. {Nope}

This went on for months. But with every call, we learned new bits of information that helped us move toward a possible solution. The point is, CALL everyone involved. You can’t afford not to.

How to Dispute a Medical Bill - Call Everyone Involved

3. File an Appeal

One of the things that came out of our excessive phone calls, was to file an appeal with the insurance company. Every company has a process where you can file an appeal, two, sometimes three times.

Once you do this, make sure you tell your healthcare provider that you’ve filed an appeal. They should push back the due date for your bill while an appeal is filed, and that way, it won’t get sent to collections without you knowing it.

In my case, I filed two appeals, but both were denied. However, this step works for many, so it’s too important not to skip!

4. Contact Your State’s Insurance Commissioner

I had no idea that State Insurance Commissioners even existed, but basically, they are the government agency in charge of making sure insurance providers are complying with the law. They contact both the provider and the insurance company on your behalf. And they know all the laws and regulations!

Even though most of our phone calls resulted in a dead end, there was one that contained the golden nugget of information we were looking for. The hospital manager {this was probably our third call to the hospital} told us to contact the Florida Insurance Commissioner to see what they could do for us. She even provided us with a form letter to help make our case!

We sent the letter and contacted the commissioner to follow up and make sure they received it. Within 60 days I received a letter from my insurance company, and the commissioner, telling me that the bill was 100% covered. FINALLY.

After 18 months of frustration, we had won!!

How to Dispute a Medical Bill - We WON!

But wow, those 18 months were long. In fact, let’s back up and take a look at the timeline again:

  • My medical procedure was done in June 2015.
  • I received my first bill in early 2016.
  • My final letter of resolution from the Insurance commissioner arrived on January 24th of 2017.

During that time, the due date of my bill got postponed for appeals three separate times. The bill was sent to collections in December 2016, one month before it was paid. Apparently, the anesthesiologist was done playing ball, although he had promised they would wait until the appeals were done. Grrrr.

Countless times along the way, I thought of just throwing in the towel and paying the bill. Especially when it got sent to collections. I have AMAZING credit and I really, really, didn’t want to ruin it. But I kept reminding myself that I pay my insurance premiums for a reason—to cover my medical expenses when I have them. What is the point of insurance if it isn’t there for me when I need it? So I refused to give up.

The moral of the story is, I don’t want you to give up either.

If you’re facing a medical bill and are not sure where to turn, research your coverage. Call EVERYONE. File appeals. Contact your commissioner. And even when you are most discouraged, do not give up. Give it your best fight.

You deserve that chance. And if you find out that yes, you do owe money on that bill? Then be a good citizen and pay it. But not without exploring your other options first.

Have you ever disputed a medical bill?

Disclosure: Some of the links in the post above are affiliate links. This means if you click on the link and purchase the item, I will receive an affiliate commission. Regardless, I only recommend products or services I use personally and believe will add value to my readers. Read my full disclosure policy here.

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  1. I had a colonoscopy at an outpatient gastroenterologist surgical center. Original Medicare covered all the bills until this latest one. The claim was for $2545 for microscopic analysis of 6 specimens. What’s odd is the previous claim, which Medicare covered, was for the same billing code (88305) but for 3 specimens. I had three polyps removed. After Original Medicare denied the claim, the provider sent me a bill for $2545 minus the total sum they had received from Medicare for all of the other claims submitted. I am being billed for $1272. I had resisted getting a colonoscopy until I was eligible for Medicare to avoid dealing with the billing. I thought there wouldn’t be a problem with billing once I was insured under original Medicare with a supplement. Unfortunately, I was wrong. It appears that the provider wants $2545 for the procedure. Since Medicare did not pay them enough, they simply filed a bogus claim knowing Medicare would deny it so they could then bill me for the residual so the sum total they get for the procedure is $2545. Our medical care system is SO SCREWED UP.

  2. Yes, I just got a $1759.00 bill from Loma Linda Hospital. They said I signed for the procedure, but everyone always signs and initials the papers presented to them. I am age 83, with cancer, and this is my life savings.

  3. I have an issue that maybe you can help me with. I had a biopsy performed in Oct or 2021. The results were not what was expected and the lab threw away my samples. The doctor wanted 1 other test done and the lab didn’t know and didn’t do it. So, I paid for this biopsy. Then, I had to have a second one done and this one was also messed up. I think the doctor’s assistant didn’t label the sample correctly. Anyway, this biopsy resulted in no result, but I was billed for it. I haven’t paid for this yet and am planning to dispute this bill. I had a 3rd biopsy scheduled, this one was to be free of charge. Well, they called me and told me that since it was late in the afternoon onDec. 23rd, they thought another lab mishap would happen so they rescheduled the biopsy. Then 2 days before my biopsy, the doctor had emergency surgery and my appointment was scheduled. It was rescheduled for Feb. 17th, but has now been bumped to Feb. 3rd. I am beyond exhausted with this whole thing, but I need to know how to successfully dispute the bill for the 2nd biopsy. Any help would be appreciated.

    1. Hi Jeanette,
      How frustrating! It sounds like the lab techs are not very competent. If you don’t feel like you should be responsible for that second bill (and it doesn’t sound like you should), then try every other avenue possible to get the bill dropped before you pay it. Once you pay a bill, it’s even harder to get that money refunded later on. If the doctor refuses to disregard the bill, your next step is to dispute it through your insurance company. They usually have an appeals process you can go through where you submit your comments and all supporting paperwork. Make sure you document everything along the way too. I hope that helps!

  4. It is now 2021 I am just receiving medical bills from 2015 – 2020..I never received any notice regarding these .I had a different insurance company in 2015 .how do i dispute these was sent to a collection agency and the office and collection agency have different billing amounts..i never received these Bill’s and have gone to the same physician since 2015. i was supposed to get service and they cancelled my appts because of this outstanding bill…how do I begin to dispute these charges.

  5. Thank you,
    I received a treatment 4 or 5 times at the same hospital. This time the same treatment cost me double $20,000 instead of $10,000, when I called they said that extra charge is because they had left over of the medicine and they have to charge me for it. I have at least 5 phone calls and a lots of chats, each time my invoice goes to revision and then I receive the same invoice.
    I will try all your tips!

  6. HI Kalyn,
    Thank you for taking the time to answer .
    Yes I did contact my insurance and they do their job . I will try to document everything the best I can . MY lanlord ( i am a roomate ) made me a witness letter to say he witness when the clinic told by phone that I was approved even thought I was not .
    I ma waiting for the documentation fo the request from the insurance to check if they request everything as I expect thme now to make mistakes and mistake as they are good at that .I found also the Mayo clinic policy about billin . Their policy says that in case of mistakes on their part , they should not bill the patient more that what the out of pocket of th epaitient at the rate negociated by their insurance . They di dnot tell me that needless to say . There policy also says that if the patient has an attorney they do go for collectors agency .
    Thank you very much Genevieve

    Thnak you very much

    1. Hi Genevieve,

      That’s good. But I just wanted to clarify something – the insurance commissioner is different than your insurance company. The insurance commissioner is a government official who is supposed to keep track and regulate insurance companies to make sure they are not cheating their customers.

      To find out how to contact your insurance commissioner you can google “Florida Insurance Commissioner” only replace Florida with the state you live in.

      1. Hi Miss Kalyn, THank you very much for your explanations . I will find the florida comissionnar as I live in Florida.
        Do you think I should contact the attorney general of minnesota or Florida please ?
        Thank you very much ,

  7. Hi Miss ,
    I was schedules in Mayo clinic rochester Minnesota and ask to my insurance blue option to approve it . Th einsurance told me the request i sodne by mayo clinic and I should not call back . I said so to mayo clinic that called me some days later telling me that I was approved . I asked are you sure the scans and the RMI as well . They confirmed ot me . So I took a airfair and hotel reservation and went . after 3 days of consultations and testing thye wanted more to be done . I asked if they were following up the process adminsitratively they told me to contact the insurance . I called them to learn that they had never heard from Mayo clinic and that they would not aprove post request . I called back mayo clinic and they told me we will make the post request and work with the denial if they do not pay we will work with you . understant we will milk you for everythng . The bill was vertignous 15000$ for 2 scan, 1 RMI, 4 consultations ! hopefully I had stopped there bu t, during the week end all while I was back in florida it became 18 000$. Now I do nto knwo how to defend myself they have tricked me into coming to there facility pretending I was approved as I was not forcing me into debt I woudl have never take the risk of . I have a small income as a retired and I am very sick and intead of first class care I got first class crookness and slevery by debt . Now all my time is consumed into finding a solution . If you have nay insight please help me I am in Fl

    1. Hi Genevieve,

      I’m so sorry that happened to you! I hope you the procedures helped get you some medical answers. As far as financial answers, everything I know right now is in this post. Have you tried contacting the insurance commissioner? That was what finally worked for us.

      Also – Document everything!

      1. HI Miss ,
        thnak you for your answer .
        Yes I did try to contact the assurance commissionner ( agent right I ma not a native English language )
        I ma writting a oposing bill letter and I found their policy that says they should not bill other thna our inusrance if they made msitakes including not asking for aproval on time . I have also made a witness my land lord made me also a witness letter of their misleading phone cll when they told me I was approved when I was not ( I use his tellephone )
        I am wondering what is the Authority above Mayo clinic I could sent the letter too with all thecopies do you knwo what is the ultimate authority in USA for this kind of issues please ?
        Thank you very much ,

  8. This all begins at the doctors office; Improper coding and ind incompetent coder allow insurance companies and
    providers opportunities to extort unearned payments through harassing billing techniques. they are counting on you you giving up. Never give up Most of the the problem result in the fact that doctors insurance companies and providers do not follow the rule they set up through their lobby’sand politicians They made it so complicated that the politicians hide behind the complexity to do nothing.

  9. Hello Kalyn,

    I just received a bill from a lab work I never requested from a doctor. I’m currently uninsured and paid up in cash for the visit over a month ago and I get a bill in the mail for over $1200 from Quest Diagnostics today. The doctor had established that it was a yeast infection and told me that the micanazole ointment that I’ve been applying is working. She prescribed me fluconazole and sent me on my way and I thought that was the end of it. I also have perfect credit that I don’t want ruined and I feel like crying. How do you file an appeal if you don’t have insurance? Is there a way to stop it going to collection while disputing it? I would appreciate any and all help.

    1. Hi Sunny,

      I’m sorry for the delayed response.

      I would encourage you to keep contacting your providers. Each time you talk to them let them know that you are uninsured. Let them know how they can solve your problem (do you want a discount? Do you want a payment plan? Let them know what would make you happy.) Some providers have special rates for uninsured patients. I’d also encourage you to do some research to find out how much these doctors get from insurance companies for the same tests (it’s usually far less than the amount that is actually charged). You may be able to use that information to negotiate a lower bill.

      The biggest thing is to be persistent!

  10. You’re not old enough (thank your lucky stars!) to have Medicare, but after it was gutted by almost a trillion dollars to kick-start Obamacare, significant cuts to coverage had to be implemented. My primary care doctor has found new and inventive ways to turn Annual Wellness visits (no copay) into much more expensive visits, simply by recoding them. All he has to do is deviate, oh-so-slightly, from the wellness regimen–asking just ONE question that’s not on the form is enough–then he can recode the appt, charge Medicare (taxpayers) hundreds more, and collect a copay, to boot!

    Even after realizing that was his group’s practice, it still took one more recoded appointment to learn how to avoid it. I got a tongue depressor and two 3” x 3” sticky notes–on which I wrote, “Wellness Question?” I stuck the stickies together, over the end of the tongue depressor and raised it after every question my doctor asked me. FINALLY, he told me, he would tell me if he was deviating from the script. That was the first time I had an official Wellness Exam, enough for him to refill my prescriptions, and it didn’t cost me a dime.

    Doctors offices are companies striving to extract every dollar they can from insurance and their customers…after all, there are cars, mortgages, private schools and piano lessons to pay for! These companies have staff dedicated solely to billing insurance companies…it doesn’t mean said staff is good, necessarily…and when it’s not…or actually schemes to defraud customers and insurance companies/agencies, that’s when we have to speak up and say, no.

    It might seem hard, at first, but it’s worth it in the long run.

    1. That’s so awesome that you took control of your visit, and so sad that you had to.

      I’m so grateful that our current doctor is very VERY helpful, sometimes even combining a visit with Joseph and I so that it costs us less. He has even gave us his personal cell phone number so that we could ask him whether or not we should come in and see him, or just take some OTC drugs and sleep it off. I think he’s one of the few “old school” doctors left that take care of their patients before their pocketbooks.

  11. Free health care is NEVER free. Canadians pay through the nose in the form of MUCH higher taxes than do Americans. I like Kalyn’s tips for dealing with–no matter what you might think–the BEST health care system in the world. A college acquaintance of mine, from Toronto, got both of his ”new” knees here, in the States. He felt the cash was worth a year and a half’s time he would have had to wait for that ”optional surgery.”

    Something less optional, heart bypass surgery, took place a full FIVE MONTHS after it was ordered. He couldn’t afford to hop on down for that one. He is one of many, many thousands of Canucks who rely on our doctors and hospitals, despite having ”free” health care, up North.

  12. Hi,
    I am having a problem with a surgery bill that I paid, in full, upfront, but still keeps growing month by month. I live in FL as well but I couldnt find anywhere on the State Insurance Commissioner site that seemed to address health insurance billing. I was wondering if you would share the number and form letter? I would really appreciate it.
    Great blog….thank you for getting your story out there.

  13. I received an immunization as a pre-op protocol for pancreatic surgery. Medicare denied payment through its Part B but indicated that it was covered by Part D prescription plan. Thehealth care provider refuses to submit the required completed form and the 11 digit NDC code to the Part D drug plan for payment. The drug plan has approved payment pending receipt of form and code… for over a year the medical provider ( a major health provider) refuses to submit the 2 items and continues to bill me for the entire cost. Every month the argument continues with no resolution….any suggestions are appreciated. The stress from it is beginning to cause related health issues…

    1. First – and probably the hardest, is try very hard not to let it stress you. It’s easy to let it get to you because it’s unresolved and probably because any conversations you have about it aren’t pleasant.

      Second – Stay persistent. Keep contacting all parties involved. At some point, you may get someone who will actually be able to help.

      Third – Have you tried contacting your states insurance commissioner yet?

  14. Hi Kalyn,

    Great piece–seems very similar to what we’re going through right now. My wife gave birth to our beautiful girl a couple months ago. Today we opened our mail to find a $6000+ medical bill that was by a non-participant Dr. in the hospital; about a month ago we received another bill for around $1300, also for services from another non-participating Dr. in the same hospital! We also did our due diligence prior to selecting the hospital and OBGYN where we’ll go into labor! We made sure both were in-network! Unbeknownst to us, while we were in the hospital, a couple of non-participating doctors provided service without our knowledge (or given an option) that they were not participating doctors. We have sent my health insurance company letters to appeal these charges but have not back yet! Any advice or suggestions on what we should do next (I’m in process of looking up our state/NJ’s Insurance Commissioner. Thanks in advance!

  15. Wow this is an insane story! I can’t believe you had to go through that. I had a similar issue with insurance saying we hadn’t paid when we did. How much did this ordeal effect your credit?

    1. Last we checked, it had not affected our credit because the reporting agencies had not yet been made aware that it went to collections. It was resolved within 30-60 days of going to collections so there is a chance we escaped unscathed. We’ll be checking again soon though to see.

  16. In the past I worked for a major health insurance carrier. I learned that most patholigist, radiologist and anesthesiologist are non contracted providers. Submitting an appeal with the rational that you had no control over the selection of these providers usually will help to get your claim reprocessed as in network and reduce the amount you owe. Especially if you had any kind of inpatient or emergency treatment. Never pay the bill first! Fight first, because trying to get a refund from the dr. will not be an easy process. Always advise the payment calls you are seeking to have to claim reprocessed. Request to have any motion to move to collections postponed, that you will pay the bill once the claim is processed appropriately. I had to fight a claim reprocess for about two years, it was not fun, but it saved the $500 I shouldn’t have been billed for.

    1. Great advice Melissa! Thanks for the information. In our case, we had the claim re-processed twice but the insurance company never budged until we contacted the Florida insurance commissioner. I hope that most insurance companies would be a little quicker in understanding the situation.

    2. My wife and I made the mistake of paying the bill and waiting for reimbursment. Had a $700 set of extra charges when my wife was pregnant that we believed would eventually be paid by insurance. We paid the balance so that it wouldn’t go to collections and hit our credit. We worked with the insurance company and DID get them to pay it, then were told we’d get a check from the hospital once they saw that a double payment had been made. That check never came and getting a hold of their medical billing department was impossible without an open bill. We ate the cost as a lesson learned.

  17. I received a $2500+ bill in the mail that I had to fight for months. I was in college and went to the hospital due to getting a stomach virus from a volunteer trip in Peru, and they took a stool sample which ended up costing me almost $1000 alone. I had no idea that something that takes 2 seconds to do would end up costing so much. Now, I refrain from going to the hospital at all costs or will ask up front how much something is going to cost me. It’s really tough living in America with our health care system!

    1. It’s so tough to know everything about what you insurance covers and what it doesn’t, especially when you are in a situation where the only thing you care about is feeling better. Joseph and I try make sure we know what hospitals and doctors are covered beforehand so that we are prepared for when we have an emergency.

    2. Yes, think twice before you go to hospital or emergency, they are crooks there! I was feeling dizzy and headache for a few days after my return from a trip, a 24hour plane ride. So on saturday I went to the emergency and the doctor diagnosed me having Vertigo. Got a blood test, she did not wait to see the results of my test. She sent me home. She tried calling me and the next day she called again and told me to come back just for a blood sample again cause the level of my medication was high yesterday. I said no I”m feeling fine now.she said don’t worry it will be very fast, in and out, no waiting. So I went, I told them Im here just for my blood sample, one thing I learned,nobody listens to you. To make the this short, I got admitted to the hospital that evening. I asked numerous time to leave, but the nurse told me if I leave my insurance will not pay for anything.
      I did not leave the hospital till the next day at noon. The bill came up to about $9,000 and my portion is $5,900. No I am not paying and I am going thru everything to not pay them. Its criminal and its a fraud!!! I was perfectly fine. Now, i will never go to emergency or hospital. To tell you this, I have never been in a hospital except to give birth to my son 30 years ago. Anyway, we learn.

      1. Wow Jeannie,

        I would certainly fight that bill! I’d also look into “urgent care” centers in your area. We avoid the emergency rooms for anything short of a catastrophic sickness or injury and visit urgent care clinics for anything else.

  18. Next step is to dispute any negative information in your credit report resulting from this. Take all your paperwork trail, make copies and send to all the three big bureaus. In the end you didn’t owe the money so it should not affect your score.

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