How to Get an Itemized Medical Bill and Check It

Written by Aptiva Health Editorial Team · Reviewed by Crystal Brake, RCM Director and Taylor Sorrels, Esq. · Editorial & review standards · How we research

Most medical bills show only a total, or a few lines grouped by type. An itemized bill is different. It lists each charge on its own line: the date, what was done, the billing code, how many units, and the price.

You need an itemized bill to check whether a bill is right. This guide explains how to ask for one, what to look for, and what to do if you find a mistake. It is part of the Coverage & Appeals Center.

Itemized bill, summary bill and EOB: what’s the difference?

If you have insurance, you will usually check the itemized bill against your EOB. If you don’t have or use insurance, you can check it against your good faith estimate. See disputing a bill that’s far above your estimate.

Your right to ask

Anyone can ask for an itemized bill. Some laws also set deadlines.

• Kentucky. When a paying patient asks, a health facility must send one free copy of the itemized statement within 30 days of discharge or 15 days of the request, whichever is later (KRS 216B.250(2)(a)). Each bill must say that you can ask for an itemized statement (KRS 216B.250(2)(b)). The facility must also have staff who can explain the charges (KRS 216B.250(5)).
• Medicare. If you have Medicare, you can ask any doctor, provider or supplier in writing for an itemized statement. They must send it within 30 days. You then have 90 days to send a written request for a review of items you think were not provided or were billed twice (42 U.S.C. 1395b-7(b)).
• Indiana. Ask the hospital’s billing office for an itemized bill, and check with your plan or the Indiana Department of Insurance about any Indiana rules.

Even without a law that applies to you, most billing offices will send one if you ask.

How to get an itemized bill

1. Find the account number. It is on the top of your bill or statement.
2. Call the billing office. Ask for “an itemized bill with billing codes” for the dates of service. Write down the date, the name of the person, and any reference number.
3. Put it in writing. Send the sample letter below by mail, fax or the patient portal. A written request gives you proof of the date you asked.
4. Ask for the codes. Ask for CPT or HCPCS codes for each service and revenue codes for hospital charges. Without codes, it is hard to check the bill.
5. Ask for a hold. Ask the billing office to pause the account while you review it. Get the answer in writing if you can.
6. Get your EOB. If you have insurance, get the EOB for the same dates from your plan’s website or app.

What to check on an itemized bill

Go line by line. Use a highlighter for anything you don’t understand.

Your information

• Your name, date of birth and insurance ID are correct.
• The bill was sent to the right health plan. A wrong member ID can cause a denial.

Duplicate charges

• The same code, on the same date, more than once. Some repeats are correct (for example, two units of a therapy service). Others are mistakes.
• The same supply or medicine listed twice under different names.

Services you didn’t get

• Tests that were ordered but canceled.
• Medicines or supplies you refused, did not use, or brought from home.
• Extra days. For a hospital stay, check that the room charges match the nights you stayed.

Dates and units

• The date of service matches your visit.
• The number of units makes sense. Some codes are billed in 15-minute units.

Coding

• Visit level. Office visit codes come in levels. A higher level costs more. Does the level fit the visit you had?
• The right body part or side. For example, a left knee X-ray billed as both knees.
• “With” vs. “without.” For example, an MRI with contrast billed when you had one without.
• Codes that don’t match your diagnosis. If the plan denied a claim because of a code, see coding error denials.

You can look up a denial code on your EOB with the denial decoder.

The math

• Add the lines. Do they match the total?
• Subtract any payments you made. Are they all there?
• If you have insurance, does your share match the “you may owe” amount on your EOB?

Surprise out-of-network charges

• A doctor you never met, such as an anesthesiologist or radiologist, billed you at out-of-network rates after care at an in-network hospital. Federal law protects you from many of these bills (CMS: Medical bill rights). See balance billing and out-of-network denials.

Your sample letter

[Your name]
[Your address] · [Your phone] · [Your email]

[Date]

[Provider or hospital name] — Billing Office
[Address or fax from your bill]

RE: Request for itemized bill
Patient name: [Name] · Date of birth: [Date]
Account number: [Number]
Date(s) of service: [Date or dates]

To the Billing Office:

Please send me a complete itemized bill for the account and dates listed above. For each charge, please include:
- The date of service
- A description of the service, supply or medicine
- The CPT, HCPCS or revenue code
- The number of units
- The charge for each line
- Any payments, insurance payments and adjustments

[If you have insurance:] Please also tell me the date the claim was sent to my health plan, [plan name], and the member ID you used.

[If you are in Kentucky and this is a hospital or other health facility:] I am a paying patient asking for my itemized statement under KRS 216B.250.

[If you have Medicare:] I am a Medicare beneficiary asking for an itemized statement under 42 U.S.C. 1395b-7(b).

While I review the bill, please place my account on hold and do not send it to collections. Please confirm this in writing.

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

Sincerely,
[Signature]
[Printed name]

If you find a mistake

1. Call the billing office. Point to the line, the code and the date. Ask them to explain it or correct it.
2. Ask for a corrected bill. If the provider also billed your plan, ask them to send a corrected claim to the plan.
3. Ask your plan to reprocess. After a corrected claim, check your new EOB.
4. Appeal if the plan still says no. See the Coverage & Appeals Center and use the appeal deadline calculator so you don’t miss a deadline.
5. Medicare only: you can send a written request for review within 90 days of getting the itemized statement (42 U.S.C. 1395b-7(b)(3)).

If the bill is right but you can’t pay it, see how to negotiate a medical bill.

Common mistakes

• Paying before you check. It is easier to fix a bill before you pay it than to get a refund later.
• Asking only by phone. A written request shows the date you asked.
• Checking the bill without the EOB. If you have insurance, the EOB tells you what you really owe.
• Not asking for codes. A description like “lab services” doesn’t tell you what was done.
• Ignoring the bill while you wait. Tell the billing office you are reviewing it, and keep notes of every call.

Need help with an Aptiva bill?

If you are an Aptiva patient and something on your bill doesn’t look right, contact our billing team.

For a denied claim, start at the Coverage & Appeals Center or use the appeal letter builder.