How To Dispute a Medical Bill and Protect Your Practice’s Patient Relationships

Disputing medical bills is a widespread trend among modern patients. Many have learned that challenging, questioning, or disputing bills can lead their provider to reduce the total amount owed, so patients often attempt this strategy before making any payments.

As a practice owner, you may be all too familiar with this costly challenge. You also know that some medical bill disputes stem from billing errors and surprise charges that your practice has to spend time and money resolving. So when patients search “how to dispute a medical bill,” you need a professional response.

Practices that offer proactive billing communications and clearly convey upfront cost estimates may experience fewer disputes and faster collections overall. The right communication tools can help you reduce the conditions that lead to disputes while making resolution faster and less disruptive when problems do occur.

Below, learn how patients dispute medical bills, what your practice should do in response, and how to mitigate the risk of disputes moving forward.

What is a medical bill dispute?

Medical bill disputes arise when a patient believes their bill contains an error. This might include an incorrect charge or a discrepancy between what their insurance was supposed to cover and what they were billed. Some patients dispute bills simply to lower their final costs, even if they do not see any obvious problems.

On the practice side, disputes can stem from a range of mistakes, including:

• Coding errors
• Duplicate charges
• Incorrect patient information
• Insurance processing mistakes
• Failure to communicate a patient’s responsibility before a visit

A commonly cited statistic estimates that upwards of 80% of all medical bills have errors. As a result, more and more patients have begun disputing their bills. During an official dispute process, the payment timeline is often put on hold, giving patients more time to pay the bill even if the balance is not actually adjusted.

Evaluating your method of handling medical bill disputes is an important step in promoting patient satisfaction and retention in your practice. If you have experienced a high volume of disputes, it may be time to audit your processes and understand where errors are stemming from.

Why medical bill disputes happen

Legitimate medical bill disputes arise from a range of issues that can cause a patient’s bill to be incorrect. The most common causes include:

• Errors in assigning medical codes to the procedures performed
• Insurance eligibility mistakes, in which medical providers assumed a patient’s insurance coverage would apply to an appointment when it did not
• Unexpected out-of-pocket costs, in which a patient is presented with a bill that is much higher than they expected
• Billing statements that are difficult to understand, leading patients to question whether they were charged accurately

Patients who receive a bill significantly higher than they expected are far more likely to dispute it, especially when they were not given an accurate cost estimate (or any cost estimate) before their visit. This highlights the importance of providing transparent estimates before a patient’s appointment.

Many practices use fragmented billing systems in which processes such as scheduling, insurance verification, and billing do not share data in real time. This increases the likelihood of producing errors that trigger disputes.

When patients feel ignored or confused during the billing process, they are more likely to escalate a concern into a formal dispute rather than resolving it through direct communication with the practice. Taking concerns seriously and providing an open line of communication with patients can help you mitigate the severity of billing disputes.

If your practice is prone to billing errors, you can seriously diminish patient trust over time. Taking the time to identify the sources of billing disputes and resolve them is important to protecting your practice’s reputation.

Billing errors and coding mistakes

The medical billing process is complex and multi-faceted, which means there are several points in which errors could arise. A few common sources of mistakes include:

• Assigning incorrect CPR or diagnosis codes
• Duplicating charges
• Entering data incorrectly

Even small errors in patient demographics or insurance information can cause delays or inaccuracies in the claims process, increasing the risk that patient balances do not accurately reflect their financial responsibility.

Many medical practices feel overwhelmed by high patient volumes and have insufficient time to double-check their work after drafting medical bills. When errors and delays arise, they spend more time fixing them, further reducing the time they have to dedicate to the billing process as a whole.

One straightforward solution to minimize billing errors is to use integrated, comprehensive practice management systems rather than disconnected tools. When you rely on different tools for scheduling, documentation, and billing, discrepancies between systems can lead to billing errors.

Errors in insurance verification can also lead to claim disputes. You need to verify a patient’s insurance eligibility before the appointment to avoid surprise post-appointment bills. Consider implementing automated eligibility verification tools to check coverage at the time of scheduling.

Lack of upfront cost communication that leads to surprise billing 

Patients often dispute bills because they are shocked by steep balances. They may have had no idea that their out-of-pocket costs would be so high and feel unprepared to pay such expensive bills.

When patients receive an accurate cost estimate before their appointments, they are much less likely to dispute the bill because they already knew what to expect. Even if the balance is high, they will not be surprised by it. They can also confirm that the estimate matches the actual costs, decreasing the likelihood that they will question or challenge the bill.

Another common trigger of patient billing disputes is surprise bills that arrive weeks after a visit. Patients may believe they have already paid for the appointment in full, only to receive another bill that appears unnecessary or inaccurate.

Providing upfront cost estimates and explanations of insurance coverage can help mitigate this issue. The goal is to remove uncertainty that commonly leads to post-visit disputes.

Your practice also needs to adhere to the federal No Surprises Act, which protects patients from receiving unexpectedly large medical bills for out-of-network care. This act bans balance billing in many scenarios, which is charging the difference between the provider’s fee and the insurer’s allowed amount.

Sending a pre-visit text or email to confirm the patient’s estimated responsibility and then verifying that bills align with those estimates can help you set clear expectations and avoid surprises.

How to dispute a medical bill: A patient’s perspective

Understanding the process for disputing a medical bill from a patient’s perspective can help you improve your workflows by giving you a better idea of what to expect. Patients typically follow this process:

1. Reviewing documents: Insured patients start by reviewing the Explanation of Benefits from their insurance company and comparing it against the statement they received from their provider.
2. Requesting an itemized bill: Patients have the right to request an itemized bill from any healthcare provider, and this is often an initial step in identifying specific charges they believe are incorrect. In some cases, the itemized bill may have a lower total than the initial bill sent because the initial bill was inaccurate.
3. Sending a formal dispute letter: If the patient finds discrepancies between their health insurance policy and the billed amount, or errors in charges sent to them, they may submit a formal dispute letter to your practice.
4. Awaiting a response from the provider: You can review the disputed bill for errors and determine whether the patient’s concerns are legitimate. Your practice may present the patient with financial assistance options if they cannot afford the bill up front.

Patients may dispute inaccurate medical collections with credit bureaus if their unpaid bills are reported, although credit bureaus often wait 365 days before adding medical collections to a credit report.

While sending a formal dispute letter is an option for patients, they may be willing to resolve the concern informally if they feel heard and have access to a clear explanation of charges. You might want to consider presenting resolution options, such as payment plans or correcting the statement outright, to avoid a more time-consuming dispute process.

Giving patients an easy way to ask billing questions via text or digital messaging could also help you resolve disputes faster.

How practices can prevent medical bill disputes

While you can’t stop every instance of medical bill disputes in your practice, you can take measures to reduce the frequency of these issues.

• Prioritize accurate, transparent billing communication at every stage of the patient journey. This reduces surprises and helps patients feel informed.
• Verify insurance eligibility before every appointment. This eliminates coverage gaps and processing errors that often lead to unexpected patient balances.
• Send clear, itemized statements with plain-language explanations of charges to reduce patient confusion. Avoid using acronyms or jargon that the average patient wouldn’t know offhand.
• Offer flexible payment plans and multiple payment channels, including text-to-pay and online payment portals, to give patients viable methods of resolving their balances. This can prevent them from feeling that bill disputes are their only options.
• Determine estimated patient responsibility at the time of scheduling to set financial expectations before care is delivered.

Altogether, transparent communication about billing is integral to preventing disputes in your practice.

How communication tools reduce medical bill disputes

Leveraging the right communication tools can help you prioritize billing transparency without adding significant workload to your front desk staff. Communication tools can enable you to send automated texts and emails to patients after calculating their estimates, minimizing the need for manual communications.

You can also use tools that offer two-way texting, allowing patients to quickly ask billing questions and receive fast responses from your practice. They won’t need to navigate a phone tree or wait for a callback, making them more likely to ask questions about confusing billing statements rather than immediately initiating a dispute.

Weave’s communication platform enables practices to send automated billing communications and respond to patient questions via text. Using an integrated communication tool like Weave helps you identify and resolve billing concerns early in the process, as it pulls data from other platforms to ensure real-time accuracy.

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What to do when a patient disputes a bill

Following the right steps after a patient disputes a medical bill can help you mitigate the negative consequences of this action. Here is an action plan to consider for your practice:

1. Acknowledge the patient’s concern promptly and create a clear path to review and resolution.
2. Provide an itemized statement quickly; this often helps resolve concerns without further escalation.
3. Direct concerned patients to staff who are trained to handle billing questions with empathy and transparency.
4. Offer a payment plan or adjusted balance as part of the dispute resolution process; this is often more cost-effective than wading through a long dispute process or losing patients altogether.
5. Document the dispute resolution process thoroughly and look for large-scale patterns in billing errors to address root causes.

How Weave helps practices prevent and resolve medical bill disputes

Weave is an all-in-one communication and patient engagement platform built specifically for small and mid-sized healthcare practices, including veterinary, dental, and optometry practices. With Weave’s features, you can streamline and automate communication to give patients an easy way to ask questions and seek clarity about their medical bills.

Weave integrates with a wide range of practice management systems to ensure your billing communications are always informed by up-to-date patient and account data. This platform is designed specifically for healthcare practices that need intuitive, user-friendly tools that they can begin leveraging quickly.

See how Weave can help your practice reduce billing disputes

If your practice has seen a rising number of medical bill disputes, it’s time to identify the source of the problem and take steps to mitigate it. Practices with the lowest dispute rates are often those that invest in clear, upfront communication and accessible patient support.

Ready to see how Weave’s communication and payment tools can support your dispute mitigation strategy? Request a demo today.