One of the most rewarding aspects of serving as a patient advocate is helping people realize they have the right—and the responsibility—to understand the medical bills they receive.
Recently, a client contacted me after receiving an unexpected balance-due bill for approximately $3,300 related to his wife’s medical treatment. Like so many patients, he wasn’t trying to avoid paying his bill. He simply wanted to know whether the charges were accurate, reasonable, and supported by appropriate medical billing documentation.
As a Registered Nurse Consultant with more than three decades specializing in medical bill review, the first thing I looked for was the CPT (Current Procedural Terminology) codes that identify the services performed.
They weren’t there.
Without CPT codes, it is impossible to independently evaluate whether the services billed were appropriate, whether the coding accurately reflects the care provided, or whether the charges can be compared to recognized reimbursement methodologies. Simply put, patients deserve enough information to understand what they are being asked to pay.
I recommended that my client send a courteous email to the treatment provider explaining that he had retained a Registered Nurse Consultant to review the bill, but that the review could not be completed because the billing statement lacked the CPT codes necessary for evaluation.
When two weeks passed without a response, I encouraged him to remain professional and persistent. Rather than becoming frustrated, he continued following up every two weeks using the same email thread, labeling each message “Second Request,” “Third Request,” and so forth. He carefully documented every communication, creating a clear chronology of his good-faith efforts to obtain the information needed to review the charges.
Approximately two months later, I received a phone call that made both of us smile.
The provider contacted him and offered to resolve the entire $3,300 balance for $600.
He gladly accepted the settlement, paid the agreed-upon amount, and the matter was closed.
Does this prove the original charges were incorrect? No. But it does demonstrate something incredibly important: when patients ask thoughtful questions, request appropriate documentation, and maintain respectful, well-documented communication, providers often take a fresh look at an account and may be willing to explore a reasonable resolution.
At the Patient Advocate Alliance, we believe informed patients make empowered decisions. Our goal is not to encourage patients to challenge every medical bill—it is to encourage them to understand every medical bill.
Healthcare billing is complex. Patients should never feel intimidated for asking questions or requesting the documentation necessary to evaluate what they are being charged. Transparency benefits everyone: patients, providers, and the healthcare system as a whole.
This experience reinforces a principle I have shared with clients throughout my career:
Don’t ignore a medical bill—but don’t assume you must simply pay it exactly as presented. Ask questions. Request the supporting documentation. Keep careful records of your communications. An informed patient is often in the strongest position to reach a fair and equitable resolution.
At the Patient Advocate Alliance, we believe that knowledge, respectful communication, and persistence are among the most powerful tools a patient can have.
