The American healthcare system has one of the highest price tags in the world—and no reliable receipts. It’s normal to feel overwhelmed when a confusing, overpriced hospital bill shows up in your mailbox. But you don’t have to take it lying down.

This guide exists to give you leverage. At Fairdoc, we use federal transparency laws and machine-readable data to surface what insurers actually pay. The price you’re seeing on your bill probably isn’t what anyone else paid. We’ll help you find out what’s fair, what’s wrong, and what to do next.

This guide has three parts:

Part 1: Understanding Your Bill
Part 2: Fixing the Problem
Part 3: Getting Outside Help

Part 1: Understanding Your Bill

Before you challenge a bill, you need to understand what it says and what it hides. Here’s the key to decoding your bill:

• Billed Charges: The "rack rate" hospitals list for services. Often 4–5 times what insurance actually pays. Think of it as a sticker price no one’s expected to pay.

• Insurance Adjustments: Discounts negotiated between your insurer and the hospital. These reduce the bill, but only if they’re applied.

• Insurance Payments: What your insurer actually paid. If this is zero, that’s a red flag.

• Balance / Patient Responsibility: What they say you owe. This might include a deductible or co-insurance, but it might also include inflated or erroneous charges.
  
  

Check your hospital bill against your Explanation of Benefits (EOB). They should match. If they don’t, you may have a problem worth pursuing.

Part 2: Fixing the Problem

Most billing issues fall into four categories. Figure out which one applies before moving forward:

1. Price Gouging

You’re being charged far above normal rates. This usually happens to uninsured patients or those without applied discounts. Fairdoc’s platform lets you compare your bill to negotiated insurer rates using Transparency in Coverage data.

What to do: Use the CPT code on your bill to find insurer-negotiated prices for that service in your ZIP code. Fairdoc can help you find a fair price, then write a formal request for reduction.

2. Insurance Denials

You went in-network. Insurance said no. You’re stuck with the bill.

What to do: Find out why. Sometimes it’s a paperwork error. Sometimes they say the treatment wasn’t “medically necessary.” Appeal the denial with supporting documents from your provider. Fairdoc can generate documentation and walk you through the appeal steps.

3. Balance Billing

Even if you went in-network, the hospital might bill you for the amount they discounted for insurance. This is almost always illegal under their contract.

What to do: Compare your EOB and hospital bill. If they’re charging you the plan discount, contact the hospital and insurer. Fairdoc flags balance billing automatically and can help draft a dispute.

4. Billing Errors

Duplicate charges, services never received, or “upcoding” for more expensive procedures.

What to do: Request an itemized bill. Compare every charge to your medical records. Flag services you didn’t receive. Tools like Find-A-Code or Healthcare Bluebook can help you verify coding errors.

Part 3: Getting Help

Some cases are simple. Others are stacked against you. If you’re not getting anywhere, here are your options:

Fairdoc Dispute Support

We’ll scan your bill, match it to published insurer data, flag inflated or illegal charges, and prepare a ready-to-send dispute packet. You don’t need legal expertise. Just your documents.

Hospital Financial Aid

Nonprofit hospitals are required to offer aid to low-income patients. You may qualify even if your income is up to 400% of the federal poverty level.

State Medicaid or CHIP

If you or your child were uninsured at the time of care, look into Medicaid or CHIP eligibility. Some states allow retroactive coverage.

Patient Advocates

Billing advocates can negotiate on your behalf for a fee or percentage of savings. Fairdoc offers a low-cost option using data automation.

Final Thoughts

Don’t assume your bill is correct. Most aren’t.
Don’t assume it’s fair. It probably isn’t.
And don’t assume there’s nothing you can do. There is.

Use this guide. Use Fairdoc. Use your voice.
You don’t have to pay the price just because they wrote it down.