How do I dispute an emergency room bill?

Start by requesting an itemized bill and your UB-04 form from the hospital. Compare the CPT billing codes to your medical records, and look for upcoding, duplicate charges, or services you did not receive. MedicalBillReview.net can review your bill for free and identify errors you can formally dispute.

Is the ER bill review completely free?

Yes. MedicalBillReview.net provides a completely free, independent review of your emergency room bill. There is no cost to you at any point.

What is upcoding on a medical bill?

Upcoding is when a hospital bills for a higher level of care than was actually provided. For example, billing CPT code 99285 (the highest complexity ER visit) when the actual visit was a routine 99282. This is one of the most common and costly billing errors on ER bills, and it is something we specifically check for in every review.

What does the No Surprises Act cover for ER bills?

The No Surprises Act protects patients from unexpected out-of-network charges at in-network facilities, including emergency rooms. In most cases, you cannot be billed more than your in-network cost-sharing amount for emergency care, regardless of which doctor treated you.

What billing errors are most common on ER bills?

The most common ER billing errors include: upcoding (billing a higher level of care than provided), unbundling (charging separately for services included in a flat rate), duplicate billing (charging twice for the same service), and errors in medication quantities or supply units.

How do I get an itemized bill from a hospital?

You have a legal right to an itemized medical bill. Contact the hospital billing department and specifically request an itemized statement and the UB-04 claim form. Under federal law, hospitals must provide your medical records within 30 days of a written request.

ER Facility Fees Explained — Why They Make Up Most of Your Bill

The facility fee is often the largest and most confusing part of an ER bill. It is a charge intended to cover the hospital's overhead costs for maintaining the emergency department. Because these fees are based on the "level of care" provided, they are a common area for billing errors and upcoding.

Can I Dispute a Facility Fee?

Yes — you can dispute a facility fee if the level of care billed (Levels 1–5) does not match the actual severity of your visit or the resources used. Requesting an itemized bill is the first step in challenging an unfair facility fee.

What Is Included in an ER Facility Fee?

Nursing staff time and supervision
Use of the emergency department room and equipment
24/7 operational overhead of the ER
Administrative and support staff costs

The facility fee is separate from the physician's professional fee. This is why most ER patients receive two separate bills: one from the hospital (facility) and one from the physician's group.

Why Facility Fees Vary So Much

ER level designation (Level 1 trauma center vs. community ER)
Geographic location and local cost of living
Hospital ownership type (non-profit vs. for-profit)
The specific CPT level assigned (99281–99285)

Common Facility Fee Billing Errors

Facility fee billed at Level 4 or 5 for a routine, brief visit
Facility level does not match the physician's documented care level
Facility fee charged for services rendered in a clinic, not an ER
Duplicate facility charges on the same bill

How to Challenge a Facility Fee

Request your itemized bill and identify the facility fee line item
Check the level (1–5) assigned and compare to your visit complexity
Request your nursing notes and physician note to verify the documented level
Contact the billing department and ask for a formal coding review

Get a free facility fee review →