A medical bill I don’t understand or can’t pay

Don’t ignore the bill, and don’t pay it in a panic. The CFPB says to make sure the bill is calculated correctly and that you owe it before you pay, and to check for financial assistance you may be able to claim.

Is this bill real, and is it right? Quick checks

• Is it really from your provider? Call the billing office using a number you trust, like the one on your provider’s website or your paperwork from the visit. The FTC warns some companies use paid search ads to look like an official bill-pay site. To pay, type in the web address or call the number printed on your bill.
• Do you actually owe it? The CFPB says you may have already paid it, or the provider or debt collector may have confused you with someone with a similar name.
• Are the charges right? The CFPB says to look for services you didn’t get, the same service charged twice, insurance payments that aren’t reflected, or care marked “out-of-network” when it wasn’t.
• A demand to pay by gift card is a scam. The FTC says no real business will ever ask you to pay with a gift card.

Do this right now

1. Don’t ignore it. The CFPB warns that doing nothing can lead to late fees and interest, debt collection, lawsuits, garnishments, and lower credit scores.
2. Ask for an itemized bill (a list of every charge). Use our letter template.
3. If you have insurance, compare the bill to your EOB (explanation of benefits) from your insurer.
4. Call the billing office about anything that looks wrong. The CFPB says to do this quickly so charges get fixed and you avoid late fees and interest.
5. Ask about financial assistance (sometimes called charity care), especially at a nonprofit hospital. Use our letter template.
6. If insurance denied the claim, appeal. The CFPB says you have a right to an internal appeal and an external review.
7. Keep copies of every bill, EOB, and letter, and notes of each call (date, name, what they said).

Check your EOB (explanation of benefits)

CMS (the Centers for Medicare & Medicaid Services) says an EOB isn’t a bill. It shows the total charges for your visit, how much your health plan covers, and what you’ll pay when you get a bill from your provider. It lists the date of service, a description of each service, and a claim number. Match your bill to the EOB line by line. If they don’t match, call your health plan (its phone number is on the EOB) and the provider’s billing office.

Surprise bills and the No Surprises Act

The No Surprises Act is a federal law that took effect January 1, 2022. The CFPB says that if you have health insurance, it protects you from certain surprise bills, for example out-of-network charges for emergency services. In those situations it can protect you from owing the difference between what the out-of-network provider billed and what your insurance paid. The CFPB notes that some services, such as ground ambulance rides, are not protected by the No Surprises Act.

Questions? CMS runs the No Surprises Help Desk at 1-800-985-3059, with help in many languages.

No insurance, or not using it? Good faith estimates and disputes

• Get a good faith estimate. CMS says that if you don’t have or don’t use insurance, providers usually must give you an estimate of expected charges when you schedule care at least 3 business days ahead, or if you ask for one. Tell the provider in advance that you’re not using insurance. You won’t get an estimate during emergency care.
• Keep the estimate to compare with your final bill.
• Dispute a bill that’s at least $400 more than the estimate. CMS runs a “patient-provider dispute resolution” process. You need an initial bill dated within the last 120 calendar days (about 4 months), and there’s a $25 non-refundable fee. If the decision is in your favor, the $25 is taken off what you owe the provider.
• While a dispute is open, CMS says your provider can’t move the bill into collections or threaten to, can’t collect late fees until the dispute ends, and can’t take action against you for disputing. CMS also says your costs won’t go up because you disputed.

Learn about or start a dispute at CMS

Appeal an insurance denial

• Internal appeal: HealthCare.gov says you must file within 180 days (6 months) of getting notice that your claim was denied. Use your insurer’s forms, or write to your insurer with your name, claim number, and health insurance ID number. Add anything that helps, like a letter from your doctor. HealthCare.gov says your state’s Consumer Assistance Program can file an appeal for you.
• External review: if the insurer still says no, you can ask for an independent external review. HealthCare.gov says to file a written request within 4 months after you get the final denial. Your insurer is required by law to accept the external reviewer’s decision.
• Urgent? HealthCare.gov says you can ask for an external review at the same time as your internal appeal.
• Medicare, Medicaid, and some job-based plans may have different appeal steps. Follow the instructions in your denial letter.

Hospital financial assistance (charity care)

The CFPB says the Affordable Care Act requires nonprofit (501(c)(3)) hospitals to have financial assistance programs, and that some states have charity care laws that require more. Under section 501(r) of the tax code, the IRS says a nonprofit hospital must:

• Have a written financial assistance policy that covers emergency and other medically necessary care.
• Make the policy, the application form, and a plain-language summary widely available on a website, and offer free paper copies on request, by mail and in places like the emergency room and admissions areas.
• Not charge someone who qualifies more than the “amounts generally billed” for emergency or medically necessary care.
• Make reasonable efforts to find out if you qualify before taking “extraordinary collection actions.” The IRS says these include selling your debt, reporting it to credit bureaus, and actions that need a court, like a lawsuit, a lien, or wage garnishment. Generally the hospital must give you notice and wait at least 120 days from the first bill after you leave before starting them, and you have a 240-day application period from that first bill.

What to do: ask the hospital billing office for its financial assistance policy, plain-language summary, and application, or look on its website. Apply even if you’re not sure you qualify, and ask them to hold the bill while they review it. Not sure if the hospital is nonprofit? Ask the billing office.

On Medicare with limited income? The CFPB says if you’re covered by the Qualified Medicare Beneficiary (QMB) program, providers should not bill you for Medicare-covered services, including deductibles, coinsurance, and copays. If a provider won’t stop billing you, call 1-800-MEDICARE (1-800-633-4227).

Medical debt and your credit report (as of Oct 2026)

• A CFPB rule from January 2025 that would have kept most medical debt off credit reports is not in effect. The CFPB says a federal court in the Eastern District of Texas vacated it on July 11, 2025.
• The CFPB’s current answer: unpaid medical debt that is more than 365 days delinquent from the date of service and over $500 could appear on your credit reports.
• Check your reports for free at AnnualCreditReport.com. The CFPB says if you find mistakes you can dispute them, and that you can also dispute a medical bill with a debt collector or a credit reporting company.
• The CFPB notes that state laws may give you more protection. Ask your state attorney general’s office (see Find help).

Template letters

Copy or print these. Send by mail or the provider’s patient portal, keep a copy, and write down the date you sent it.

[Your name]
[Your address]
[Your phone or email]
[Date]

[Provider or hospital name]
Billing Department
[Billing address from your bill]

Re: Request for itemized bill
Patient name: [patient name]
Account number: [account number from the bill]
Date(s) of service: [date(s)]

Dear Billing Department,

Please send me a complete itemized bill for the account above. Please list each charge separately, with the date, a description of each service or item, the billing code (such as a CPT, HCPCS, or revenue code), the quantity, and the charge for each line. Please also show all payments and adjustments, including what my insurance paid.

While I review the itemized bill, please put this account on hold and do not send it to collections.

Thank you. You can reach me at [phone or email].

Sincerely,
[Your name]

[Your name]
[Your address]
[Your phone or email]
[Date]

[Provider or hospital name]
Billing Department
[Billing address from your bill]

Re: Billing dispute
Patient name: [patient name]
Account number: [account number]
Date(s) of service: [date(s)]
Insurance claim number (if any): [claim number from your EOB]

Dear Billing Department,

I am writing to dispute the following charges on this account:

1. [Date, description, amount] - [reason, for example: "I did not receive this service," "This was charged twice," "My EOB shows I owe a different amount," "This was billed as out-of-network but the provider is in my network"]
2. [Next charge and reason]

I have enclosed copies of [the itemized bill / my EOB / receipts]. Please review these charges, correct the bill, and send me an updated statement.

Please do not send this account to collections or report it to a credit bureau while the dispute is being reviewed.

Thank you. You can reach me at [phone or email].

Sincerely,
[Your name]

Enclosures: [list the copies you are sending; keep your originals]

[Your name]
[Your address]
[Your phone or email]
[Date]

[Hospital name]
Billing / Financial Assistance Office
[Address from your bill]

Re: Request for financial assistance application
Patient name: [patient name]
Account number: [account number]
Date(s) of service: [date(s)]

Dear Financial Assistance Office,

I am having trouble paying this bill. Please send me:

- Your financial assistance policy (charity care policy),
- The plain-language summary of that policy, and
- The application form, with a list of any documents I need to include.

Please review this account for financial assistance. While my application is being considered, please put the account on hold and do not send it to collections or report it to a credit bureau.

If I do not qualify for free care, please tell me about any discounts or payment plans.

Thank you. You can reach me at [phone or email].

Sincerely,
[Your name]

Free help

• No Surprises Help Desk (CMS): 1-800-985-3059.
• Medicare questions: 1-800-MEDICARE (1-800-633-4227), and free counseling from your State Health Insurance Assistance Program (SHIP) at shiphelp.org.
• Local help paying bills: call 211 or visit 211.org.
• Problems with a debt collector or a credit report: you can submit a complaint to the CFPB at consumerfinance.gov/complaint.