Request to review a charge

Here is a polite letter asking the billing office to review the charge and confirm the outcome in writing, with a hold on collections meanwhile. Check the details, fill in the bracketed parts and send it yourself.

Use it when a line looks wrong or higher than expected and you want the billing office to review it. · Checked 28 September 2026

The letter

This is the draft Med Bill Check writes. On the home page you can add your details and, for a review letter, the code and amount, and it fills them in. Anything in [brackets] is for you to complete.

[Your full name]
[Your address]
[Your phone or email]
[Today's date]

Billing Department
[Provider or hospital name]
[Provider address]

Re: Account number [account number], date of service [date of service], patient [patient name]

Dear Billing Department,

I am writing to ask you to review a charge on the account above: [service], billed at [amount]. [Say briefly what you would like checked, for example a service you do not recognize, a duplicate line, or a charge that seems higher than expected.]

Please check that this charge and its code are correct, send me an itemized bill with codes if you have not already, and tell me the outcome in writing. If any part of the bill is adjusted, please send an updated statement.

Please put the account on hold and do not send it to collections while the review is underway.

Thank you for your help. I look forward to hearing from you.

Sincerely,
[Your name]

Tips

• Keep a copy of everything you send, and note the date and the name of anyone you speak to.
• If you have insurance, call your insurer too. They can check whether the claim was processed correctly.
• If you were uninsured or self-pay and got a Good Faith Estimate, a bill $400 or more above it may qualify for the federal dispute process within 120 days of the bill date.

Adding Medicare's benchmark

Give a code and the amount charged and the letter adds a paragraph like this one, for CPT 99214 at $540:

For reference, Medicare's 2026 fee schedule rate for code 99214 nationally is about $136, and Medicare's published data shows providers nationally typically billed about $276 in 2024.

For a hospital charge it gives the hospital outpatient rate as well as the doctor's part. Look up a code.

Your rights

• No Surprises Act. Since 2022, most people with health insurance are protected from surprise bills for most emergency care, for out-of-network providers at in-network hospitals and surgery centers, and for air ambulances. You should only owe your in-network cost sharing. Official page
• Good Faith Estimate. If you are uninsured or not using insurance, providers must usually give you a Good Faith Estimate when you book care at least 3 business days ahead, or when you ask for one. Official page
• Bill above your estimate. If a provider bills at least $400 more than its Good Faith Estimate, you may be able to use the federal patient-provider dispute process. Start within 120 calendar days of the date on the bill. The fee is $25. Official page
• Free help. The No Surprises Help Desk answers questions about these rights on 1-800-985-3059. Official page

Other letters

• Request for an itemized bill
• Request for a prompt-pay or self-pay discount
• Request for financial assistance (charity care)

Sources

• https://www.cms.gov/nosurprises
• https://www.irs.gov/charities-non-profits/billing-and-collections-section-501r6
• https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency

This is a draft for you to review, edit and send yourself. It is general information, not legal, medical or financial advice. Med Bill Check never sends anything for you.