How do I dispute a medical bill that I believe has incorrect coding or charges in California?

To dispute an incorrect medical bill in California, you must formally challenge the charges with both the medical provider and your health insurance plan. The process involves requesting detailed records, filing formal disputes, and escalating to state regulators if necessary. Here is a step-by-step guide to disputing an incorrect medical bill: Step 1: Request an Itemized Bill and Explanation of Benefits (EOB) Under California law (Health & Safety Code § 1339.51), you have the right to request a detailed, itemized bill from the medical provider, who must provide it within 30 days. Simultaneously, obtain the Explanation of Benefits (EOB) from your health insurer for that date of service. Compare these two documents to identify specific errors, such as incorrect billing codes (CPT codes), duplicate charges, or services you never received. Step 2: Contact the Provider’s Billing Department Call the provider’s billing office to informally discuss the errors you found. Clearly state which charges you are disputing and why. Take detailed notes of the call, including the date, the name of the person you spoke with, and the outcome. If they agree to make a correction, ask for confirmation in writing. Step 3: Submit a Formal Written Dispute to the Provider If a phone call does not resolve the issue, send a formal dispute letter to the provider via certified mail with a return receipt. In the letter, include your name, patient account number, and the date of service. Clearly list the disputed charges and provide a brief explanation for why they are incorrect. Attach copies (not originals) of your itemized bill and EOB with the errors highlighted. Request that they pause any collection activity while the bill is in dispute. Step 4: File a Formal Grievance with Your Health Plan You must also dispute the charge with your health insurance plan by filing a formal grievance, as required by the Knox-Keene Act. Your plan's website or the back of your insurance card will have instructions for the grievance process. You typically have 180 days from the date of service to file. The health plan must investigate and resolve your grievance within 30 days. Step 5: Escalate to a State Regulatory Agency If your health plan denies your grievance, you can appeal the decision to an external state agency. For most HMOs and some PPOs, you will file a request for an Independent Medical Review (IMR) with the California Department of Managed Health Care (DMHC). For other plans, you will file a complaint with the California Department of Insurance (CDI). Important considerations: Do not ignore the bill during this process. Keep meticulous records of all communications, including letters, emails, and phone call notes. Be aware of California's surprise billing law (AB 72), which protects you from certain unexpected bills from out-of-network providers at in-network facilities. Note: This process can be time-consuming. Persistently follow up on your dispute. Paying the undisputed portion of the bill can sometimes show good faith and prevent the entire amount from being sent to collections. This is general information and does not constitute legal advice. For complex situations, consult with a qualified California attorney.