Itemized Hospital Bills

What is an itemized hospital bill?

An itemized hospital bill is a breakdown of all charges, line by line. It includes the hospital’s internal “revenue code” (the internal code the hospital uses to determine their charge), the CPT or HCPCS code (used to identify what services were provided), and charges for each line item.

How to get an itemized bill from a hospital?

The itemized hospital bill is not sent automatically. You will usually only be mailed your standard hospital bill. In order to get an itemized bill from your hospital, you should call the number on your standard hospital bill and ask specifically for the Itemized Hospital Bill. Hospitals are required by law to provide it upon request. Be clear and direct, explaining: “I would like an itemized bill.”

Understanding your itemized hospital bill

Hospital bills can be overwhelming. Let’s break down your itemized hospital bills piece by piece below.

The Amount You Owe (“Balance”)

The amount you owe (“balance”) is the result of subtracting insurance adjustments and the insurance payment from billed charges.

1. Billed Charges: These are the “full-rack” rates that the hospital charges only to uninsured patients. Insurance companies never pay this rate and neither should you. Each billed line item should have a “revenue code” listing the price and a CPT or HCPS code identifying the service provided.
2. Insurance Adjustments: The discount that the insurance company has pre-negotiated with the hospital.
3. Insurance Payment: The amount that the insurance company actually pays the hospital.
4. Balance: The billed charges remaining after the insurance adjustment and the insurance payment are subtracted, this is the amount the hospital says you owe. If you have insurance, this may be a copay or deductible.

Itemized hospital bill terminology to know

• Gross Charges: Billed charges are sometimes listed as “gross charges”
• Chargemaster Rate: Billed charges are sometimes listed as the “Chargemaster Rate”
• Contractual Amount: The insurance adjustment is sometimes referred to as the “Contractual Amount”
• Contractual Discount: The insurance adjustment is sometimes referred to as the “Contractual Discount”
• Allowed Amount: The insurance payment is also known as the “Allowed Amount”
• Patient Portion: The patient portion is the balance after insurance adjustments and payments
• Revenue Code: The internal code the hospital uses to determine their charge
• CPT (or HCPCS) Code: the internal code that identifies what services were provided

Beyond hospital bill charges, you may also find it helpful to understand certain key health insurance terms when discussing your medical bill with your insurance company or hospital.

Tips for reviewing your Itemized hospital bill

• Check the math on your itemized hospital bill: Make sure the balance is equal to the billed charges minus the insurance adjustment and the insurance payment.
• Confirm the plan discount: iIf you are insured, make sure a Plan Discount is itemized on the bill. If not, call your insurance company.

If your itemized hospital bill is confusing or you’re dealing with outrageous medical bills and need help negotiating your bill, you’re not alone. Get in touch with our expert medical bill advocates at Resolve today.