How to check and dispute a hospital bill
Ask the hospital for an itemized bill with a CPT or HCPCS code on every line, compare each code with the price the hospital itself publishes, and write to the billing office asking to be billed its published cash price. At a nonprofit hospital, also ask for its Financial Assistance Policy: you can apply up to 240 days after the first bill. If you had a Good Faith Estimate and the bill is $400 or more above it, you can dispute it with CMS within 120 days.
Checked against cms.gov and irs.gov on 2026-10-01
1. Get the itemized bill
The first statement is usually a summary: a few totals by department. Ask the billing office for the itemized version, in writing, and ask it to hold the account while you review it:
Re: Account number [number], patient [name], date of service [date]
Please send me a fully itemized bill for this account, listing for each charge the date of service, the CPT or HCPCS code, the revenue code, the description, the quantity and the amount.
Please also tell me whether this account was billed to any insurer, and do not refer it to collections while I review the charges.
[Your name, address, phone]
2. Check every line
Look for charges you do not recognize, the same charge twice, quantities that look wrong (ten units of a drug you got once) and services you were told were included. Then look up each code: search it on SelfPayRates, open the hospital's page, and compare the bill with the cash price from the hospital's own file. Each hospital page links to that file. At the hospitals we track, a knee MRI without contrast (73721) has a median cash price of $1,843; one hospital in ten charges $581 or less, and one in ten $4,976 or more.
Bills from the radiologist, surgeon or anesthesiologist usually come separately from the hospital's bill; a hospital's published price for a code is its own charge, not theirs.
3. Ask to be billed the published cash price
Federal rules make every hospital publish its discounted cash price for each service (45 CFR 180.50). If you paid or are paying yourself and the bill is higher, quote the hospital's own number back to it:
Re: Account number [number], date of service [date]
I was billed $[amount] for [service], code [CPT/HCPCS]. Your hospital's published price file, dated [file date] ([file link]), lists a discounted cash price of $[price] for this code.
I am a self-pay patient and ask that this charge be adjusted to your published cash price. Please send me a corrected itemized bill.
[Your name, address, phone]
4. Apply for financial assistance
Nonprofit hospitals must have a written Financial Assistance Policy and a free application, and patients who qualify cannot be charged more for emergency or medically necessary care than the hospital generally bills insured patients (Internal Revenue Code section 501(r)). You can apply up to 240 days after the first bill, and the hospital must wait at least 120 days after that bill before collection actions such as credit reporting or a lawsuit. Each hospital page on SelfPayRates says whether the hospital is nonprofit, government-owned or for-profit.
Re: Account number [number], date of service [date]
Please send me your Financial Assistance Policy, its plain language summary and the application form. I was uninsured for this care [or: my household income is about $[amount] for [number] people].
Please do not refer this account to collections or report it to a credit agency while my application is pending.
[Your name, address, phone]
5. If the bill is above your Good Faith Estimate
If you were uninsured or not using insurance and got a Good Faith Estimate before scheduled care, a bill that is $400 or more above the estimate for any one provider or facility can be disputed through CMS within 120 days of the bill, for a $25 fee. How the Good Faith Estimate and the dispute work.
6. Negotiate what is left
Ask the billing office whether it gives a discount for paying the balance in full, and whether it offers an interest-free payment plan. Get any agreement in writing before you pay, and keep copies of every letter and receipt.
Questions
Does the hospital have to give me an itemized bill?
Hospitals routinely send one on request, and several states require it by law. Ask in writing and keep a copy of the request.
Is the hospital's published cash price the most it can charge me?
The published price is the hospital's standard charge for a self-pay patient for that code, not a legal cap; the final bill can add separately billed services. It is the hospital's own number, which makes it a strong reference when you ask for an adjustment.
Can a nonprofit hospital send my bill to collections while I apply for financial assistance?
Under section 501(r), once you submit a complete application the hospital must suspend collection actions such as credit reporting or a lawsuit until it decides. It also cannot start them earlier than 120 days after the first bill.
This page explains federal rules in plain words; it is not legal advice. Your state may give you more protection.