What a plan looks like when it lands in your inbox
This is a whole plan, written on an example emergency room bill. The findings, the prices and the steps are exactly what you receive. The call script and the letters are shown as a preview, because the finished ones are written around your account number, your dates and your codes.
The visit below is a composite, not a customer. Every price in it is real: the list and cash medians come from one health system's published price file, the same ones in our breakdown of what an ER visit costs. Your hospital's numbers will differ. The shape of the bill will not.
The bill
Emergency room visit for abdominal pain, seen at level 4, blood and urine tests, IV fluids and one IV medicine, a CT of the abdomen and pelvis, home the same day. No insurance. Nonprofit hospital. First statement three weeks ago, total $14,315, no itemized bill yet, nothing paid.
What we found
The bill is at list price, not the price this hospital publishes for people paying without insurance
Every line on this statement is the gross charge. The same eight lines come to $4,564 at the discounted cash price the hospital publishes in its own machine-readable file, against $14,315 as billed. That price is not a discount anyone has to grant you. It is already written down, and asking for it is step three.
One IV push injection is billed twice
Code 96374 appears on two lines, timed three minutes apart, for one recorded administration in the notes. Either the second push happened and belongs on the bill with a matching entry in the record, or it is a duplicate and comes off. The itemized bill settles it, which is why the itemized bill is step two.
The CT is coded with contrast and the discharge summary says without
The bill carries 74177, a CT of the abdomen and pelvis with contrast. The discharge summary describes a scan without contrast, which is a different code. This is the single largest line on the bill, so it is worth resolving before anything is paid or settled.
What this bill should cost
Line by line, as billed and at the price the hospital already publishes for people paying without insurance.
| Line on the bill | As billed | Published cash price |
|---|---|---|
| Level 4 ER visit, facility fee (99284) | $3,227 | $1,131 |
| Blood draw (36415) | $56 | $20 |
| Complete blood count (85025) | $241 | $76 |
| Comprehensive metabolic panel (80053) | $527 | $180 |
| Urinalysis (81001) | $151 | $58 |
| IV fluids, first hour (96360) | $980 | $322 |
| IV push injection (96374) | $708 | $210 |
| CT abdomen and pelvis with contrast (74177) | $8,425 | $2,567 |
| Hospital total | $14,315 | $4,564 |
The cash price is not an offer we are making and not a settlement figure. It is the hospital's own published price for someone paying without insurance, and it is the number the rest of the plan works from.
What this bill qualifies for
Three routes are open on this bill, and they are worth different amounts, so the order in the next section is not arbitrary.
The published cash price
Open to anyone paying without insurance, on every line, today. Worth $9,751 on this bill on its own.
The hospital's financial assistance policy
This is a nonprofit hospital, so the policy is a public document with written income thresholds, and anyone approved under it cannot be charged more than the amounts generally billed to insured patients. Your plan quotes your hospital's actual policy and thresholds, not a general rule.
The two disputed lines
A duplicate injection and a contrast code that does not match the discharge summary. Neither is a negotiation. They are corrections, and they come off before anyone talks about what you can pay.
Your plan, in order
Step 1 · Before anything else
Do not pay any of it yet
A balance that has been paid is much harder to reduce, and most hospital assistance policies apply to what is still outstanding. Nothing below asks you to hand over money, and nothing here puts you at risk in the meantime: this hospital is a nonprofit, and it cannot start extraordinary collection action for at least 120 days after the first statement.
Step 2 · Today
Ask for the itemized bill, from both the hospital and the physician group
The statement you have shows totals. The itemized bill shows every code, every time stamp and every unit, and it is the document that proves or clears findings 02 and 03. These are two separate companies and two separate requests. The script for the call is in your plan.
Step 3 · The same week
Ask for the discounted cash price on every line, in writing
Name the hospital's published price file and the eight codes on it. Put it in writing so there is a record, and do not accept a percentage off the list price as an answer: the published cash price is a number per code, and on this bill it is the difference between $14,315 and $4,564.
Step 4 · Within 240 days of the first statement
Apply for financial assistance before you negotiate anything
This hospital is a nonprofit, so it has a written assistance policy and it has to accept applications for at least 240 days from the first statement. It also cannot charge someone approved for assistance more than the amounts generally billed to insured patients, which is a cap that applies whatever the list price says. Negotiating first gives away the balance the policy would have discounted.
Step 5 · Once the itemized bill arrives
Dispute the two flagged lines with the record in hand
One duplicate injection and one contrast code, in one short letter, each with the line and the time stamp it sits on. Ask for a corrected statement rather than an explanation. The letter is in your plan with the codes already filled in.
Step 6 · Expect it in the next few weeks
Two more bills are coming, and they get the same treatment
The emergency physician bills separately from the hospital, and the radiologist who read the CT usually bills separately again. Neither is covered by anything you agree with the hospital. Same three questions each: itemized bill, cash price, assistance.
Step 7 · Last
Negotiate or settle what is left
Only after the price is right and the errors are off does the remaining balance mean anything. Ask for an interest free payment plan you can actually meet before you offer a lump sum, and never give card details on a first call.
The scripts and letters
Four documents come with this plan, written out in full and ready to send. Here is where two of them start.
Call script · billing office, asking for the itemized bill and the cash price
“Hi, I am calling about account number 4471-08822, a visit on the 9th. Two things: I need the fully itemized bill with the CPT codes, and I need the discounted cash price for each line, because I do not have insurance.”
“If they say the cash price is a flat percentage off, this is what you say next.”
Letter · financial assistance application, cover letter
“I am applying for financial assistance under your policy for the emergency room visit on the 9th, account number 4471-08822. My household is two people and my income for the last twelve months was $48,000, which places me within the thresholds in your published policy.”
“The letter then names the two lines under dispute so the balance is not finalised while they are open.”
The other two are the dispute letter for the duplicate injection and the contrast code, and the payment plan request for whatever is left at the end. In your plan all four arrive complete, with your account number, dates, codes and amounts already in them.
This one, written on your bill, is $49
You pay, create your account and upload the bill, and answer a few questions the bill cannot answer for us. The plan comes back within 24 hours.
Rather have someone make the calls for you? See the plans where we negotiate.