Hospital bills can be long, full of codes and hard to match to what actually happened during your visit. Billing mistakes do happen, and patients have rights that can lower or correct what they owe. This guide explains the documents you are likely to receive, the terms on them, the protections in the No Surprises Act, and a step-by-step way to review a bill.
This is general information, not legal or financial advice. Never avoid emergency care because of cost: in an emergency, call 911.
The documents you may receive
| Document | Who sends it | What it is |
|---|---|---|
| Summary statement | Hospital | A short bill showing totals and what you owe. Often the first thing you get |
| Itemized bill | Hospital, on request | Every charge, with dates, codes and amounts |
| Professional bills | Physician groups | Separate bills from doctors such as emergency physicians, anesthesiologists, radiologists or pathologists |
| Explanation of Benefits (EOB) | Your health insurer | What was billed, what the plan allowed, what it paid and what you owe. Not a bill |
| Medicare Summary Notice (MSN) | Medicare | The Original Medicare version of an EOB |
One hospital visit can produce several bills, because hospitals bill for facility costs and many physicians bill separately for their professional services.
Common terms on a hospital bill
- Charges: the hospital's list prices, drawn from its chargemaster. Insured patients rarely pay full charges.
- Allowed amount or negotiated rate: what your insurer has agreed to pay for a service.
- Adjustment or contractual allowance: the difference between charges and the allowed amount, written off by the hospital.
- Deductible, copay, coinsurance: your share under your plan.
- Revenue codes: codes describing the department or type of service, such as room and board, pharmacy or emergency room.
- CPT and HCPCS codes: standard codes for procedures, tests and supplies.
- ICD-10 codes: diagnosis codes.
- DRG: diagnosis-related group, used to pay many inpatient stays as one bundled amount.
- Facility fee: a charge for using the hospital's space and staff, which can also appear on visits to hospital-owned outpatient clinics.
The No Surprises Act
The No Surprises Act took effect on January 1, 2022. For people with most private health plans, it protects against surprise bills in these situations:
- Emergency care: you cannot be balance billed by an out-of-network emergency room or emergency physician. You pay no more than your in-network cost sharing.
- Non-emergency care at an in-network hospital: certain out-of-network providers, such as anesthesiologists, radiologists, pathologists, assistant surgeons and hospitalists, cannot balance bill you, and cannot ask you to waive this protection.
- Air ambulance services from out-of-network providers.
Ground ambulance services are not covered by the federal law, although some states have their own protections.
If you are uninsured or not using insurance, providers must give you a good faith estimate of expected charges for scheduled care, and on request. If your bill is $400 or more above the estimate, you can start the federal patient-provider dispute resolution process, generally within 120 days of receiving the bill.
If you believe your rights were violated, you can contact the No Surprises Help Desk run by CMS. Medicare and Medicaid patients have separate protections against balance billing.
How to review a hospital bill
- Wait for the EOB. If you are insured, compare the hospital bill to your insurer's EOB before paying. The amount you owe should match.
- Ask for an itemized bill. It lists each charge so you can check it.
- Check the basics. Your name, insurance details, dates of admission and discharge, and the doctor names should be correct.
- Look for duplicates. The same test or medication charged twice is a common error.
- Check services you did not receive. Canceled tests or medications you did not take may still appear.
- Check your status. Being billed as an outpatient under observation rather than inpatient changes your costs. See Observation vs Inpatient Status.
- Look at room charges. Check the number of days, and whether you were charged for the day of discharge, which hospitals usually do not charge.
- Ask questions. Call the hospital billing office and ask them to explain any charge you do not understand. Write down who you spoke with and when.
If you find a problem
- Billing errors: ask the hospital to correct and resubmit the claim.
- Insurance denials: you have the right to an internal appeal with your insurer and, in many cases, an independent external review.
- Medicare: follow the appeal instructions on your Medicare Summary Notice.
- Cannot afford it: ask about financial assistance, discounts for paying promptly, or an interest-free payment plan. Nonprofit hospitals must have a financial assistance policy under IRS section 501(r). See Hospital Financial Assistance.
Ask the hospital to put your account on hold while a dispute, appeal or assistance application is being reviewed.
Price transparency
Since January 1, 2021, the federal hospital price transparency rule requires hospitals to publish their standard charges, including rates negotiated with insurers, in a machine-readable file, and to make prices for shoppable services available in a consumer-friendly format. Insurers have their own transparency requirements and offer cost estimator tools. These can help you check whether a charge looks unusual.
Trauma and emergency charges
Emergency room visits are often billed by level, based on the complexity of the visit. If a trauma team was activated to meet you on arrival, you may see a trauma activation fee. See What Is a Trauma Center? and ER vs Urgent Care.