# 12 · US medical bill: request the itemized bill (step 1 of every medical bill fight)

**Use when:** you receive any hospital, ER, surgery, lab or ambulance bill you don't fully understand, or that's bigger than expected. **Do not pay a large bill based on a summary.** A summary ("Cardiology: $70,000") can't be checked. An itemized bill with codes can.

**What you're asking for:**
- An **itemized statement** with every line: date of service, description, **CPT/HCPCS code**, revenue code, units, and charge per line.
- The **UB-04** (hospital) or **CMS-1500** (doctor) claim form if insurance was billed.
- From your insurer: the **Explanation of Benefits (EOB)** for this visit.
- Your **medical records** for the visit if you need to check that you actually received what's billed (you have a right to access your records under HIPAA).

> Real example (reported by Tom's Hardware, October 2025): a family billed about $195,000 for four hours of ICU care after a relative's death requested the itemized bill, used Claude to review the codes, found duplicate and miscoded charges, and settled for about $33,000. One story, not a promise, but it shows why step 1 matters.

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## Letter / portal message

> [YOUR NAME]
> [ADDRESS] · [PHONE] · [EMAIL]
> Patient: [PATIENT NAME], date of birth [DOB]
> Account / guarantor number: [ACCOUNT NUMBER]
> Date(s) of service: [DATES]
>
> [HOSPITAL / PROVIDER] · Patient Financial Services / Billing Department
> [ADDRESS FROM THE BILL]
>
> [DATE]
>
> **Re: Request for itemized statement · account [ACCOUNT NUMBER]**
>
> Hello,
>
> I received a bill for [AMOUNT] for the dates of service above. Before paying, I need to review the charges. Please send me:
>
> 1. A complete itemized statement listing each charge with the date of service, description, CPT/HCPCS code, revenue code, number of units, and amount;
> 2. A copy of the claim form (UB-04 or CMS-1500) submitted to any insurer, if applicable;
> 3. Records of any payments, adjustments and discounts applied to the account;
> 4. Your financial assistance (charity care) policy and application.
>
> Please place the account **on hold** and do not send it to collections while I review the itemized bill. I am not refusing to pay; I am asking to verify the charges.
>
> Thank you,
> [NAME]

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## Tips
- Call the billing number and ask for the hold too: "Please note on the account that I've requested an itemized bill and ask that it's on hold from collections during the review." Write down the name, date and reference.
- **Nonprofit hospitals** must have a written **financial assistance policy** (IRS section 501(r)). Ask for it. Depending on income you may qualify for a discount or free care, even after the bill arrives.
- **Uninsured / self-pay?** You have the right to a **Good Faith Estimate** for scheduled care. If the final bill is **at least $400 more** than the estimate, you can start the federal **patient-provider dispute resolution** process within **120 calendar days** of the bill (there's a $25 fee). See cms.gov/nosurprises.
- **Insured?** Compare every line with your EOB. Surprise bills from out-of-network providers at in-network facilities and in emergencies may be limited by the **No Surprises Act**: see cms.gov/nosurprises.

Next: template 13 to review and dispute errors.