What to Do When You Get a Medical Bill: Immediate Actions

When you receive a medical bill, the actions you take in the first few days can save thousands of dollars and preserve crucial rights. This guide provides a step-by-step protocol for immediate response.

Need context? Start with Understanding Medical Debt or see our complete guide for all options.

First Response Protocol

Step 1: Open and Read Everything

Do:

• ✅ Open all mail immediately, even intimidating bills
• ✅ Note all deadlines mentioned
• ✅ Read the entire bill and any inserts

Don't:

• ❌ Throw bills away unopened
• ❌ Assume you have no options
• ❌ Make hasty payments before review
• ❌ Give payment info over phone without verifying caller legitimacy

Why: Ignoring bills eliminates options and can lead to default judgments. Paying before review forfeits opportunities for assistance, error correction, or negotiation.

Step 2: Request Itemized Bill Immediately

What to Request: A complete itemized bill (also called "detailed statement") showing:

• Date of each service
• Description of each service/supply
• Procedure codes (CPT codes)
• Diagnosis codes (ICD-10 codes)
• Quantity/units for each item
• Individual charge for each line item
• Department providing service

How to Request:

By Phone: "I need a complete itemized bill with all procedure codes, descriptions, and quantities. Please mail AND email this to me."

In Writing (Sample Letter):

[Date]
[Your Name]
[Account Number: __________]

[Hospital/Provider Billing Department]
[Address]

Subject: Request for Itemized Bill

Dear Billing Department:

I am requesting a complete itemized bill for services provided on [DATE OF SERVICE].

Please include:
• Date of each service
• Description of each service or supply
• Procedure codes (CPT) and diagnosis codes (ICD-10)
• Quantity of each item
• Individual charge for each line item

Please send this itemized bill to:
[Your mailing address]
[Your email address]

Please provide within 10 business days.

Thank you,
[Your Signature]
[Your Phone Number]

Send via: Certified mail with return receipt requested

Your Right: Federal regulations and state laws generally require providers to furnish itemized bills upon request. Timeframes vary by state (typically 10-30 days).

Why Critical: Summary bills hide errors. Research shows approximately 30% of medical bills contain errors that only become visible in itemized detail.

Source: University of Minnesota research by Prof. Stephen Parente, USA Today 2012

Step 3: Verify Insurance Processing

If you have insurance, confirm claims were properly submitted and processed.

Check Your EOB (Explanation of Benefits):

Your insurance sends an EOB after processing each claim. It shows:

• What provider billed
• What insurance allowed (negotiated rate)
• What insurance paid
• Your responsibility (and why: deductible, copay, coinsurance, or denial)

Compare EOB to Bill:

• Did provider apply insurance payments correctly?
• Does bill reflect payments shown on EOB?
• Are there charges with no matching EOB? (Claims may not have been submitted)

If Claims Weren't Submitted: Contact both billing department and insurance. Providers are generally responsible for submitting claims.

If Claims Were Denied:

• Read denial reason on EOB carefully
• Check appeal rights (typically 180 days)
• Common denials: "not medically necessary," "pre-authorization required," "out of network," "not covered"
• Many denials are successfully overturned on appeal

Step 4: Document Everything

Build a comprehensive paper trail from day one.

Create a Medical Debt File:

Physical Documents:

• All bills and statements (every version)
• Insurance EOBs
• Correspondence (letters sent and received)
• Medical records and discharge summaries
• Payment receipts
• Financial assistance applications and responses

Digital Backup:

• Scan or photograph all documents
• Save emails and screenshots
• Back up to cloud storage

Phone Call Log Template:

Date: ___________  Time: ___________
Called: ___________  Phone: ___________
Spoke with: ___________  Employee ID/Extension: ___________
Purpose of call: ___________
Summary: ___________
___________
___________
Next steps: ___________
Reference number (if given): ___________

For Important Letters:

• Send certified mail with return receipt requested
• Keep certified mail receipt and return receipt card
• Note tracking number

Step 5: Calculate Your Personal Deadlines

Using the timeline information from our guide, determine your specific deadlines:

Calculate Your Deadlines:

• First bill received date: **___**
• 240-day charity care deadline: **___**
• 180-day insurance appeal deadline (if denied): **___**
• 30-day debt validation deadline (if collection letter received): **___**
• Lawsuit response deadline (if served): **___**

See Understanding Medical Debt for complete timeline details.

Step 6: Identify Bill Origin and Type

Who Is Billing You:

Check the bill header and return address:

Look for these phrases:

• "This is an attempt to collect a debt" = Collections
• "Collection agency" = Collections
• Original provider letterhead = Direct from provider

Check Nonprofit Status: If billed by a hospital, verify if it's nonprofit at the IRS Tax Exempt Organization Search.

Type of Service:

Source: No Surprises Act Information

Priority Action Matrix

Based on your situation, here's your priority order:

Essential Documents to Gather Now

Before pursuing any resolution path, collect the appropriate documents:

Common Early Mistakes to Avoid

Paying immediately without review Even if you can afford it, review first. Once paid, recovering overpayments is difficult.

Giving payment info to callers Verify caller legitimacy. Request written verification before providing payment information.

Admitting debt or making partial payments without understanding consequences In some states, this can restart the statute of limitations. Get advice first if debt is old.

Assuming automatic charity care screening Nonprofit hospitals must tell you the program exists, but YOU must apply.

Missing deadlines 240 days (charity care), 180 days (insurance appeals), 30 days (debt validation), 20-30 days (lawsuit response).

Not getting payment arrangements in writing Verbal agreements mean nothing. Always get written agreements before payment.

Talking to collectors without knowing rights Collectors use pressure tactics. Know your FDCPA rights first.

Next Steps

You're now prepared to:

1. ✅ Identify your specific situation
2. ✅ Gather necessary documentation
3. ✅ Understand your timelines
4. ✅ Know what actions to prioritize

Proceed to the section that matches your priority:

• Financial hardship → Hospital charity care programs
• Billing errors → Nonprofit & Government Resources
• Large bills, complex situation → Professional Advocates
• Insurance issues → Automated Tools
• Need overview → Return to Complete Guide

Time-sensitive actions:

• Apply for charity care within 240 days
• Send debt validation within 30 days of first collection letter
• Respond to lawsuits within 20-30 days
• File insurance appeals within 180 days

Remember: Documentation and timely action preserve your options. The earlier you act, the more choices you have.