Medical billing terms, in plain words.
Terms from bills, insurance letters and collection notices, each explained in a sentence or two.
Last updated .
Terms are listed from A to Z. Type a word from your bill in the search box to narrow the list, or jump to a letter. Each term links to related terms and, where we have one, to the guide that explains what to do.
These definitions describe how the words are usually used on US bills and notices. Your bill, your plan's documents and the law of your state decide what applies to you.
- 124terms
- 21letters
Type a word from your bill, in this language or in English.
A
- Adjustment
A change to your balance that is not a payment, such as a discount, a correction or the part of a charge your health plan's contract says the provider cannot bill. It shows on a bill or an explanation of benefits as an amount taken off.
- Affordable Care Act
The federal health law, often called the ACA, that created the Health Insurance Marketplace and set rules for what health plans must cover. It also added the financial assistance and collection rules for nonprofit hospitals.
See alsoMarketplace planEssential health benefitsSection 501(r)
- Air ambulance
A helicopter or plane that carries patients. If you have most kinds of health insurance, the No Surprises Act protects you from surprise out-of-network bills for air ambulance services.
- Allowed amount
The most your health plan pays for a covered service, counting your share. An in-network provider generally cannot bill you for the difference between its full charge and the allowed amount.
- Amounts generally billed
What a nonprofit hospital usually gets from patients with insurance for the same care. If you qualify under its financial assistance policy, it may not charge you more than this for emergency or medically necessary care.
See alsoFinancial assistance policySection 501(r)Charity care
- Appeal
A request asking your health plan to look again at a decision not to pay for care, or to pay less than you expected. The plan's letter explains how to appeal and by when.
See alsoDenialExplanation of benefitsPrior authorizationExternal review
B
- Bad debt
Charges a hospital wrote off because a patient did not pay. It is not the same as financial assistance, which a hospital gives because a patient qualifies.
- Balance billing
When a provider bills you for the difference between its full charge and what your health plan allowed. The No Surprises Act bans it in most surprise out-of-network cases, but not for ground ambulance rides.
- Balance due
What the provider says you still owe after insurance payments, adjustments and your own payments. Check it against the itemized bill and your explanation of benefits before you pay.
- Bankruptcy
A federal court case for people who cannot pay what they owe. It can release you from many debts, though some remain, and it is a serious step with lasting effects, so talk to a bankruptcy attorney or legal aid first.
See alsoJudgmentLegal aidGarnishment
- Billing code
A short code that names a service, a supply or a diagnosis on a bill or a claim. Procedure codes such as CPT and HCPCS codes name what was done; diagnosis codes name why.
See alsoCPT codeDiagnosis codeUpcoding
- Billing office
The department of a hospital or practice that sends bills, answers questions about them, fixes mistakes and sets up payment plans. It can also tell you about financial assistance.
See alsoFinancial assistance policyPayment planStatementFinancial counselor
C
- Cash price
The price a provider charges when you pay without using insurance. Ask for it before planned care, and compare it with what your plan would leave you to pay.
See alsoSelf-paySelf-pay discountChargemasterHospital price transparency
- Cease-communication request
A written request telling a debt collector to stop contacting you about a debt. It must then stop, except to say it is ending its efforts or may take a step such as a lawsuit, but the debt does not go away and you can still be sued.
See alsoCollection agencyFair Debt Collection Practices ActDebt validation
- Centers for Medicare & Medicaid Services
The federal agency behind Medicare, Medicaid, CHIP and the Health Insurance Marketplace. It also takes complaints about surprise bills and about hospitals that do not post their prices.
See alsoMedicareMedicaidNo Surprises Act
- Chargemaster
A hospital's full list of prices for everything it bills. Few people pay these list prices: health plans pay agreed rates, and discounts and financial assistance can lower what you owe.
See alsoHospital price transparencySelf-pay discountAmounts generally billed
- Charity care
Free or discounted care a hospital gives to patients who cannot afford their bills, under its financial assistance policy. Nonprofit hospitals must have such a policy, and some states set income levels that hospitals must cover.
See alsoFinancial assistance policyFederal poverty guidelinesPresumptive eligibilitySliding scale
- CHIP
The Children's Health Insurance Program, which gives free or low-cost coverage to eligible children and, in certain states, pregnant women, in families that earn too much for Medicaid. Limits and costs differ by state.
- Claim
The bill a provider sends to your health plan asking it to pay for your care. The plan's answer comes back to you as an explanation of benefits.
- CMS-1500
The standard claim form that doctors and other professionals use to bill a health plan for their services.
- COBRA
A federal law that may let you keep job-based health coverage for a while after the job ends or after another qualifying event. You pay the whole premium yourself, including the employer's share, so compare the cost with a Marketplace plan.
See alsoEmployer-sponsored insuranceSpecial enrollment periodMarketplace plan
- Coinsurance
Your share of the cost of a covered service, as a percentage of the allowed amount, that you pay after you have met your deductible.
- Collection agency
A company that collects unpaid bills for someone else, such as a hospital. Federal debt collection rules cover collection agencies, and they must tell you how to dispute a debt.
See alsoDebt validationFair Debt Collection Practices ActDebt buyerCollectionsCease-communication request
- Collections
The stage when a provider, a collection agency or a debt buyer tries to collect an unpaid bill, usually after several statements. It can include letters, calls, credit reporting and, in some cases, a lawsuit.
See alsoCollection agencyExtraordinary collection actionCredit report
- Community benefit
What a nonprofit hospital does for its community, such as financial assistance, health programs and training, which it reports to the IRS. These hospitals must also assess their community's health needs.
- Community property
A rule in some states, Nevada among them, that property either spouse gets during a marriage belongs to both. In some of these states a surviving spouse may have to use jointly held property to pay the other spouse's debts, so ask an estate attorney.
- Consumer Financial Protection Bureau
A federal agency for consumer money matters, including debt collection and credit reports. You can send it a complaint about a collector or a credit bureau at consumerfinance.gov/complaint.
See alsoFair Debt Collection Practices ActFair Credit Reporting ActCredit bureau
- Copay
A fixed amount you pay for a covered service, such as a doctor visit or a prescription, as set by your health plan.
- Cost sharing
The part of your covered care that you pay yourself, such as deductibles, coinsurance and copays. It does not include premiums, balance bills from out-of-network providers or care your plan does not cover.
See alsoDeductibleCopayCoinsurance
- CPT code
A code from the Current Procedural Terminology list that names a medical service or procedure, such as an office visit or an X-ray. Lines on an itemized bill usually carry one, and you can look it up to check what you were charged for.
- Credit bureau
A company that collects information about how people pay their debts and sells it as credit reports. The nationwide credit bureaus are Equifax, Experian and TransUnion.
See alsoCredit reportCollectionsCredit report disputeFair Credit Reporting Act
- Credit report
A record of your loans, credit cards and some unpaid debts, kept by a credit bureau. Medical debt in collections can still appear on it in some cases. You can check your reports for free at AnnualCreditReport.com.
See alsoCredit bureauCollectionsMedical debtCredit report disputeFair Credit Reporting Act
- Credit report dispute
Telling a credit bureau that an item on your report is wrong and asking it to check. The bureau must look into it for free, and delete or correct it if it is inaccurate, incomplete or cannot be verified.
- Creditor
A person or business you owe money to, or that says you owe it money. On a medical debt, it may be the hospital or doctor, or a company that bought the debt.
D
- Date of service
The day you got the care being billed. Use it to match each charge to a visit, and to check that you were not billed for days you were not there.
See alsoItemized billStatement
- Debt buyer
A company that buys unpaid debts, often in large groups for much less than what is owed, and then tries to collect them. Debt buyers that collect follow the same federal rules as collection agencies. Some charities buy medical debt the same way and cancel it instead.
See alsoCollection agencyDebt cancellationFair Debt Collection Practices Act
- Debt cancellation
When whoever owns a debt ends your obligation to pay it. A cancelled debt is not paid: it is over, and nobody collects it. Charities that buy medical debt cancel it this way.
See alsoWrite-offForm 1099-CDebt buyer
- Debt validation
The details a debt collector must give you about a debt: who it is owed to, how much, how to dispute it and when your dispute period ends. If you dispute in writing within that period, the collector must pause collecting the disputed amount until it answers.
See alsoDisputeCollection agencyFair Debt Collection Practices Act
- Deductible
The amount you pay for covered care in a plan year before your health plan starts to pay its share.
See alsoCoinsuranceCopayOut-of-pocket maximumPremiumHigh-deductible health plan
- Default judgment
A court's decision against you because you did not answer a lawsuit or come to court. Respond to any court papers by the date on them, even if you think the debt is wrong.
See alsoSummonsJudgmentGarnishment
- Deferred interest
An offer, common on medical credit cards, that charges no interest for a set time. If any balance is left at the end, you owe all the interest back to the date of purchase, so check the end date before you agree.
See alsoMedical credit cardPayment planFinancial assistance policy
- Denial
A health plan's decision not to pay for a service, in full or in part. The explanation of benefits or a letter gives the reason, and you can usually appeal.
See alsoAppealClaimPrior authorizationMedically necessaryExternal review
- Diagnosis code
A code that names the condition or the reason for your care. Health plans use it to decide whether a service is covered, so a wrong diagnosis code can lead to a denial.
See alsoBilling codeDenial
- Dispute
Telling a provider, a collector or a credit bureau that a bill or a debt is wrong and asking them to check it. Do it in writing and keep a copy.
See alsoDebt validationPatient-provider dispute resolutionAppealCredit report dispute
- Dual eligible
Having both Medicare and Medicaid. Ask whether you are a Qualified Medicare Beneficiary: Medicare providers may not bill people in that program for Medicare deductibles, coinsurance or copays.
E
- Emergency Medicaid
Medicaid coverage of emergency care for people who meet their state's Medicaid rules except for their immigration status. Ask the hospital's financial counselor how to apply in your state.
- Employer-sponsored insurance
Health coverage an employer offers to its workers, and often to their families. Federal rules give these plans a set process and a minimum time for appealing a denied claim.
- EMTALA
The Emergency Medical Treatment and Labor Act, a federal law. Hospitals with an emergency department that take Medicare must check anyone who comes for emergency care and stabilize an emergency condition, whether or not the person can pay. It does not make the care free.
- ERISA
The Employee Retirement Income Security Act, a federal law that sets minimum standards for most health plans from private employers, including a process to appeal denied claims. It does not cover plans run by governments or churches.
- Essential health benefits
The kinds of care Marketplace plans must cover under the Affordable Care Act, such as doctor visits, hospital care, prescription drugs, pregnancy and childbirth, and mental health care. Some plans cover more, and details vary by state.
- Estate
The money and property a person leaves when they die. It pays their debts, medical bills included, as far as it can, and what it cannot cover usually goes unpaid.
- Explanation of benefits
A statement from your health plan showing what a provider billed, what the plan allowed and paid, and what you may owe. It is not a bill. Compare it with the provider's bill before you pay.
See alsoClaimAllowed amountBalance due
- External review
A review of your health plan's denial by an independent reviewer outside the plan, usually after an internal appeal, or sooner in urgent cases. Most plans must offer one, and you have a limited time to ask.
- Extraordinary collection action
A serious collection step that federal rules limit for nonprofit hospitals: selling the debt, reporting it to a credit bureau, delaying needed care over an unpaid bill, or legal steps such as a lien, a lawsuit, taking money from a bank account or garnishing wages.
See alsoSection 501(r)LienGarnishmentFinancial assistance policy
F
- Facility fee
A charge for the use of a hospital's rooms, staff and equipment, billed on top of the doctor's fee. It can appear when a clinic or a doctor's office is owned by a hospital.
See alsoProviderItemized bill
- Fair Credit Reporting Act
The federal law that sets the rules for credit reports, including how long a collection can stay on one and how a credit bureau must handle a dispute. It also limits how medical information can appear on a report.
- Fair Debt Collection Practices Act
The federal law, with its rule called Regulation F, that says what debt collectors may and may not do. It covers collection agencies, debt buyers and collection law firms, but generally not a hospital collecting its own bills in its own name.
See alsoCollection agencyDebt validationTime-barred debtConsumer Financial Protection BureauCease-communication request
- Federal poverty guidelines
Income amounts by household size that the US Department of Health and Human Services sets each year, with higher amounts for Alaska and Hawaii. Hospitals and programs often state their income limits as a percentage of them.
- Federal Trade Commission
A federal agency that protects consumers from scams and unfair business practices, including debt relief and grant scams. You can report a scam at ReportFraud.ftc.gov.
See alsoConsumer Financial Protection BureauDebt cancellationCollection agency
- Financial assistance policy
A hospital's written rules for free or discounted care: who qualifies, what it covers and how to apply. Nonprofit hospitals must have one for emergency and other medically necessary care, and must post it online for free.
See alsoCharity careAmounts generally billedPresumptive eligibilityFinancial counselorMedically necessary
- Financial counselor
A hospital staff member who helps patients with the cost of care, for example by applying for financial assistance or Medicaid or setting up a payment plan. Ask the billing office how to reach one.
- Form 1099-C
A federal tax form that some lenders and other creditors send when they cancel a debt, reporting the cancelled amount to you and to the IRS. Whether you owe tax depends on your situation, so ask a tax professional if you get one.
See alsoDebt cancellationWrite-offInternal Revenue ServiceSettlement
G
- Garnishment
A court order that lets a creditor take part of your pay, or money from your bank account, to pay a debt. It usually comes only after a lawsuit and a judgment.
- Good faith estimate
A written estimate of expected charges that uninsured or self-pay patients can usually get before scheduled care, or when they ask. If the final bill is far above it, you may be able to dispute the bill.
See alsoPatient-provider dispute resolutionNo Surprises ActSelf-pay
- Ground ambulance
An ambulance that travels by road. The No Surprises Act does not cover surprise out-of-network bills for ground ambulance rides, though some states protect you.
- Guarantor
The person responsible for paying a bill. It may be the patient, a parent of a child patient, or someone who signed to take responsibility. Check who is named before you pay a bill in your name.
H
- Hardship
When paying a bill would leave you unable to cover basic needs, for example after a job loss, an illness or a large medical bill. You can ask a hospital in writing to reduce or write off a bill because of hardship.
- Health savings account
A savings account, paired with an eligible high-deductible plan, that lets you set money aside before taxes for deductibles, copays, coinsurance and other qualified medical costs. It generally cannot be used for premiums.
See alsoHigh-deductible health planDeductibleOut-of-pocket maximum
- High-deductible health plan
A plan with a higher deductible than a traditional plan and usually a lower premium, so you pay more of your care yourself before the plan starts to pay. It can be paired with a health savings account.
- HIPAA right of access
Your right under the federal health privacy law, HIPAA, to see and get copies of your health records, including the billing and payment records a provider keeps about you.
See alsoItemized bill
- Homestead exemption
A protection in some states that lets you keep all or part of the value of your main home from creditors who have no lien on it. What it covers differs by state, so ask a legal aid office.
See alsoLienJudgmentBankruptcy
- Hospital presumptive eligibility
Short-term Medicaid that a qualified hospital can grant from basic information, so you are covered while you make a full Medicaid application. It is a Medicaid program, separate from the hospital's own financial assistance.
- Hospital price transparency
Federal rules that require every US hospital to publish its standard charges in a file computers can read, and to show prices for common services you can plan ahead in a form people can read.
See alsoChargemasterGood faith estimateSelf-pay discountCash price
I
- In-network
A provider with a contract with your health plan to accept agreed rates. Care in the network usually costs you less, and the provider generally cannot bill you above your share.
- Internal Revenue Service
The federal tax agency. Its rules cover cancelled debt, and the financial assistance and collection practices of nonprofit hospitals.
- Itemized bill
A bill that lists every charge on its own line, with the date of service, the billing code, a description, the quantity and the price. Ask for one before you pay.
See alsoStatementBilling codeDate of serviceHIPAA right of access
J
- Judgment
A court's decision that you owe a debt. Depending on state law, a creditor with a judgment may be able to garnish wages, take money from a bank account or place a lien.
See alsoSummonsGarnishmentLienDefault judgmentHomestead exemption
L
- Legal aid
Free legal help from nonprofit programs for people who cannot afford a lawyer. You can look for programs in your state at LawHelp.org.
- Lien
A legal claim on your property, such as a home, to secure a debt. It can make it hard to sell or refinance until the debt is dealt with. For nonprofit hospitals, placing a lien is an extraordinary collection action.
M
- Marketplace plan
A health plan you buy through the Health Insurance Marketplace, at HealthCare.gov or on your state's own Marketplace website. You can sign up during open enrollment, or later if a life event, such as losing other coverage, gives you a special enrollment period.
See alsoOpen enrollmentSpecial enrollment periodAffordable Care Act
- Medicaid
Public health coverage for people with low incomes, run by each state with federal funds. A provider that takes Medicaid must accept its payment, plus any allowed cost sharing, as payment in full.
See alsoRetroactive coverageEmergency MedicaidMedicareCHIPHospital presumptive eligibility
- Medical credit card
A credit card or loan for health care bills, often offered at the provider's office. Once a bill is on it, you owe the lender, not the provider, and an interest-free offer can end with interest charged. Ask about financial assistance and payment plans first.
See alsoPayment planFinancial assistance policyDeferred interest
- Medical debt
Money you still owe for health care after insurance pays its share, or when you had no insurance. It can be a bill from a hospital, a doctor, a lab or an ambulance, or medical costs put on a credit card or a loan.
- Medically necessary
Care or supplies needed to diagnose or treat an illness, injury or condition, by accepted medical standards. Health plans use these words to decide what they pay, and a nonprofit hospital's financial assistance policy must cover this care.
- Medicare
Federal health insurance for older adults and for some younger people with disabilities or certain conditions. If you have Medicare, you can ask a provider in writing for an itemized statement of your Medicare services.
See alsoQualified Medicare BeneficiaryMedicaidObservation statusMedigapMedicare Savings Program
- Medicare Savings Program
A state program that helps people with Medicare and limited income pay their premiums and, in some cases, their deductibles, coinsurance and copays. States may use higher limits than the federal ones, so apply even if you think you earn too much.
- Medigap
Extra insurance from private companies that helps pay what Original Medicare leaves to you, such as copays, coinsurance and deductibles. You generally need Medicare Part A and Part B to buy it.
N
- Network
The hospitals, doctors and other providers your health plan has a contract with. Care outside the network can cost you more, so check each provider before planned care.
- No Surprises Act
A federal law that protects people with most kinds of health insurance from most surprise out-of-network bills: for emergency care, for care connected to a visit to an in-network hospital or surgery center, and for air ambulance. It also lets uninsured patients get a good faith estimate.
See alsoBalance billingGood faith estimateGround ambulanceCenters for Medicare & Medicaid Services
- Nonprofit hospital
A hospital that does not pay federal income tax. In return it must meet federal rules: a written financial assistance policy, limits on charges and limits on collections. Most US community hospitals are nonprofits.
See alsoSection 501(r)Financial assistance policyExtraordinary collection actionCommunity benefit
O
- Observation status
When a hospital keeps you for tests or treatment as an outpatient instead of admitting you, even overnight. It can change what your plan pays and, with Medicare, whether later care in a nursing facility is covered. Ask whether you are admitted or under observation.
- Open enrollment
The time each year when you can sign up for a Marketplace plan or change plans. Job-based plans may have different dates, and you can apply for Medicaid or CHIP at any time of year.
See alsoSpecial enrollment periodMarketplace planEmployer-sponsored insurance
- Out-of-network
A provider with no contract with your health plan. You may pay more, and where the No Surprises Act does not apply, the provider may bill you for the difference between its charge and what your plan paid.
- Out-of-pocket maximum
The most you pay in a plan year for covered in-network care, through deductibles, copays and coinsurance. Once you reach it, your plan pays the full allowed amount for covered care for the rest of that year. Premiums do not count toward it.
See alsoDeductibleCoinsurancePremium
P
- Patient account number
The number a provider uses for your bill. Put it on every letter and payment, and have it ready when you call. It is not the same as your insurance member number.
See alsoStatementBilling office
- Patient advocate
Someone who helps you with bills, insurance problems or care, such as a hospital staff member, a nonprofit case manager or a private advocate you pay. Ask who pays them and what they charge before you agree to anything.
- Patient-provider dispute resolution
A federal process for uninsured or self-pay patients whose bill is far above their good faith estimate. An independent reviewer decides what you owe, and while the dispute is open the provider may not send the bill to collections.
- Payment plan
An agreement to pay a bill in monthly amounts. Ask the billing office whether it charges interest, offer only what you can keep paying, and get the terms in writing.
- Personal representative
The person in charge of an estate: an executor is named in a will, and an administrator is named by a court. Collectors may discuss the estate's debts with them but may not say they must pay from their own money, and a provider must treat them as the patient's representative for the records their role needs.
- Presumptive eligibility
When a nonprofit hospital decides, without an application, that you qualify for financial assistance, using information such as your enrollment in a public benefits program. If it gives you less than its most generous help, it must tell you why and how to apply for more.
See alsoFinancial assistance policyCharity careHospital presumptive eligibility
- Prior authorization
Approval your health plan requires before some services, drugs or equipment. Without it, the plan may refuse to pay. Ask your provider whether it has asked for one.
- Probate
The court process that handles a person's estate after they die: who is in charge, paying the debts and passing on what is left. Each state sets its own rules, so ask the probate court in the county where the person lived.
- Provider
Anyone who gives and bills for health care: a hospital, a doctor, a lab, an ambulance service or a clinic. One hospital visit can bring bills from several providers.
See alsoFacility feeIn-network
- Public charge
A test in US immigration law: officials can deny some visas and green cards to a person they find likely to depend on the government for support, looking at the whole situation, including some public benefits. These rules change often, so talk to an immigration attorney or an accredited representative before you act.
Q
- Qualified Medicare Beneficiary
A Medicare savings program for people with low incomes in which the state helps pay Medicare costs. Medicare providers may not bill people in it for Medicare deductibles, coinsurance or copays.
See alsoMedicareMedicaidMedicare Savings ProgramDual eligible
R
- Refund
Money a provider pays back, for example when you paid more than you owed or when insurance paid after you did. If a nonprofit hospital approves your financial assistance, it must refund what you paid above what you owe, apart from very small amounts.
- Retroactive coverage
Coverage that starts before the date you applied. In many states Medicaid can cover care from the months before you applied, if you would have qualified then; a recent federal law shortens that period, so ask your state's Medicaid office what applies.
See alsoMedicaidEmergency MedicaidHospital presumptive eligibility
S
- Section 501(r)
The part of the federal tax code with rules for nonprofit hospitals: a community health needs assessment, a written financial assistance policy, limits on charges and limits on billing and collections. A hospital that breaks them can lose its tax exemption.
See alsoNonprofit hospitalFinancial assistance policyExtraordinary collection actionAmounts generally billed
- Self-pay
Paying for care yourself, without insurance or without billing your plan. Self-pay patients can usually ask for a good faith estimate before scheduled care, and can ask about a discount.
See alsoSelf-pay discountGood faith estimateCash priceUninsured
- Self-pay discount
A lower price some providers give to patients who pay without insurance, or who pay the balance at once. Ask the billing office whether one applies to you.
- Settlement
An agreement to pay less than the full balance to close the account. Get it in writing before you pay, with words saying the payment settles the debt in full.
- Sliding scale
A price or discount that changes with your income, so people who earn less pay less. Some hospitals and clinics use one, often based on the federal poverty guidelines.
See alsoCharity careFederal poverty guidelinesFinancial assistance policy
- Special enrollment period
A time outside open enrollment when a life event lets you sign up for a health plan, such as losing job-based coverage, COBRA or Medicaid. The window is short, so apply soon after the change.
- Statement
A bill or summary of your account that a provider sends, often with totals only. It may not list every charge, so ask for the itemized bill.
See alsoItemized billBalance due
- Statute of limitations
The time limit, set by each state, for suing over a debt. Once it passes, a collector may not sue or threaten to sue, but it may still ask you to pay, and in some states a payment can restart the clock.
See alsoTime-barred debtSummonsJudgment
- Summons
A court paper telling you that you are being sued and how long you have to answer. Do not ignore it: if you do not respond, the court can decide against you without hearing your side.
See alsoJudgmentStatute of limitationsDefault judgmentLegal aid
T
- Time-barred debt
A debt older than the state's time limit for lawsuits. It still exists and a collector may ask for payment, but it may not sue or threaten to sue. If you are sued anyway, you must raise the time limit in court.
See alsoStatute of limitationsFair Debt Collection Practices ActSummons
U
- UB-04
The standard claim form that hospitals and other facilities use to bill a health plan. You can ask for a copy as part of your billing records.
See alsoCMS-1500ClaimItemized bill
- Uncompensated care
Care a hospital or other provider gives and never gets paid for, often because a patient has no insurance and cannot afford the bill.
- Underinsured
Having health insurance that still leaves you with costs that are high for your income. The Commonwealth Fund's surveys count an adult as underinsured when out-of-pocket costs or the deductible reach a set share of household income.
- Uninsured
Having no health insurance or public coverage such as Medicare or Medicaid. You can usually still get a good faith estimate before planned care, and you can ask any hospital about financial assistance.
- Upcoding
Billing for a more serious or more costly service than the one you got, by using a higher billing code. If a code on your bill does not match your care, ask the billing office to check it.
See alsoBilling codeCPT codeDispute
W
- Write-off
When a provider removes all or part of a balance from its books and stops trying to collect it, for example after a hardship request or a financial assistance decision. Ask for written confirmation.
Sources
Note 1 IRS, "Limitation on Charges - Section 501(r)(5)". Published July 3, 2026. Last checked November 2, 2026.
Note 2 CMS, "Medical bill rights". Published October 5, 2026. Last checked November 2, 2026.
Note 3 CMS, Advisory Committee on Ground Ambulance and Patient Billing. Published August 2024. Some states protect you from surprise ground ambulance bills. Last checked November 2, 2026.
Note 4 IRS, "Financial Assistance Policy and Emergency Medical Care Policy - Section 501(r)(4)". Published July 3, 2026. Last checked November 2, 2026.
Note 5 15 U.S.C. 1692a(6) (Cornell LII). Published 2026. Last checked November 2, 2026.
Note 6 CFPB, "What information does a debt collector have to give me about a debt?". Published January 29, 2024. Last checked November 2, 2026.
Note 7 FTC, "Free Credit Reports". Published June 2026. Last checked November 2, 2026.
Note 8 National Consumer Law Center, "The Latest on Keeping Medical Debt Out of Credit Reports". Published September 21, 2026. Court cases may change this. Last checked November 2, 2026. Last checked November 2, 2026.
Note 9 IRS, "Billing and Collections - Section 501(r)(6)". Published July 2, 2026. Last checked November 2, 2026.
Note 10 IRS Publication 4681 (2025). Published 2025. Talk to a tax professional if you are unsure. Last checked November 2, 2026.
Note 11 CMS, "Dispute a bill". Published October 2, 2026. Last checked November 2, 2026.
Note 12 HHS, HIPAA right of access guidance. Published 2026. Not every state requires an itemized bill; these are the rights we could confirm. Last checked November 2, 2026.
Note 13 CMS, "Hospital Price Transparency". Published September 16, 2026. Last checked November 2, 2026.
Note 14 42 CFR 447.15 (Cornell LII). Published 2026. Last checked November 2, 2026.
Note 15 42 U.S.C. 1395b-7(b) (Cornell LII). Published 2026. Not every state requires an itemized bill; these are the rights we could confirm. Last checked November 2, 2026.
Note 16 IRS, "Requirements for 501(c)(3) Hospitals Under the Affordable Care Act - Section 501(r)". Published July 2, 2026. Last checked November 2, 2026.
Note 17 American Hospital Association, Fast Facts on U.S. Hospitals 2026. Published February 2026. Last checked November 2, 2026.
Note 18 CMS MLN booklet MLN7936176, Prohibition on Billing Qualified Medicare Beneficiaries. Published September 2025. Last checked November 2, 2026.
Note 19 CFPB, "What is a statute of limitations on a debt?"; 12 CFR 1006.26(b). Published October 28, 2026. Last checked November 2, 2026.
Note 20 42 U.S.C. 1395dd (EMTALA), United States Code via GovInfo. Published 2024. Last checked November 3, 2026.
Note 21 42 CFR 440.255(c) (eCFR). Published 2026. Last checked November 3, 2026.
Note 22 42 CFR 435.915(a) (eCFR). Published 2026. Last checked November 3, 2026.
Note 23 Public Law 119-21 (An Act to provide for reconciliation pursuant to title II of H. Con. Res. 14), 139 Stat. 72, GovInfo. Published July 4, 2025. Last checked November 3, 2026.
Note 24 26 CFR 1.501(r)-6(c)(2) (eCFR). Published 2026. Last checked November 3, 2026.
Note 25 Affordable Care Act (ACA) (glossary). HealthCare.gov. Checked November 3, 2026.
Note 26 Health Insurance Marketplace (glossary). HealthCare.gov. Checked November 3, 2026.
Note 27 HealthCare.gov, "Special Enrollment Period". Published 2026. Last checked November 3, 2026.
Note 28 Open Enrollment Period (glossary). HealthCare.gov. Checked November 3, 2026.
Note 29 Job-based health plan (glossary). HealthCare.gov. Checked November 3, 2026.
Note 30 45 CFR 147.136 (eCFR); 29 CFR 2560.503-1(h)(3)(i). Published 2026. Last checked November 3, 2026.
Note 31 COBRA (glossary). HealthCare.gov. Checked November 3, 2026.
Note 32 ERISA. US Department of Labor. Checked November 3, 2026.
Note 33 High Deductible Health Plan (HDHP) (glossary). HealthCare.gov. Checked November 3, 2026.
Note 34 Health Savings Account (HSA) (glossary). HealthCare.gov. Checked November 3, 2026.
Note 35 Cost sharing (glossary). HealthCare.gov. Checked November 3, 2026.
Note 36 Network (glossary). HealthCare.gov. Checked November 3, 2026.
Note 37 Essential health benefits (glossary). HealthCare.gov. Checked November 3, 2026.
Note 38 HealthCare.gov, "Medicaid & CHIP coverage". Published 2026. Last checked November 3, 2026.
Note 39 Medicare.gov, "What's Medicare Supplement Insurance (Medigap)?". Published 2026. Last checked November 3, 2026.
Note 40 Medicare.gov, "Medicare Savings Programs". Published 2026. Last checked November 3, 2026.
Note 41 Medically necessary (glossary). HealthCare.gov. Checked November 3, 2026.
Note 42 Commonwealth Fund, The State of Health Insurance Coverage in 2026: Findings from the 2026 Biennial Health Insurance Survey (Collins et al.). Published October 2026. Last checked November 3, 2026.
Note 43 Instructions for Schedule H (Form 990). Internal Revenue Service. Checked November 3, 2026.
Note 44 Uncompensated care (glossary). HealthCare.gov. Checked November 3, 2026.
Note 45 Patient Advocate Foundation, Case Management Services. Published 2026. Last checked November 3, 2026.
Note 46 Alliance of Professional Health Advocates, home page. Published 2026. Last checked November 3, 2026.
Note 47 42 CFR 435.1110 (eCFR). Published 2026. Last checked November 3, 2026.
Note 48 Glossary of Legal Terms. United States Courts. Checked November 3, 2026.
Note 49 15 U.S.C. 1681i(a), United States Code via GovInfo. Published 2024. Last checked November 3, 2026.
Note 50 15 U.S.C. 1681c(a)(4), (c)(1) (Cornell LII). Published 2026. Last checked November 2, 2026.
Note 51 15 U.S.C. 1681b(g) (Cornell LII). Published 2026. Last checked November 2, 2026.
Note 52 15 U.S.C. 1692c(c), United States Code via GovInfo; 12 CFR 1006.6(c). Published 2024. Last checked November 3, 2026.
Note 53 LawHelp.org. Pro Bono Net. Checked November 3, 2026.
Note 54 FTC, "Debts and Deceased Relatives". Published February 2023. Last checked November 3, 2026.
Note 55 CFPB, "Does a person's debt go away when they die?" (Ask CFPB 1463). Published October 15, 2026. Last checked November 3, 2026.
Note 56 12 CFR 1006.2(e) and 1006.6(a)(4) (eCFR). Published 2026. Last checked November 3, 2026.
Note 57 CFPB, "Can a debt collector contact me about a deceased relative's debts?" (Ask CFPB 1469). Published October 19, 2023. Last checked November 3, 2026.
Note 58 45 CFR 164.502(g) (eCFR). Published 2026. Last checked November 3, 2026.
Note 59 Nevada Revised Statutes chapter 123 (Nevada Legislature). Published 2026. Last checked November 3, 2026.
Note 60 About CMS. Centers for Medicare & Medicaid Services. Checked November 3, 2026.
Note 61 CMS, "Submit a provider or insurer complaint". Published November 2, 2026. Last checked November 3, 2026.
Note 62 FTC, "How To Get Out of Debt". Published December 2025. Last checked November 3, 2026.
Note 63 FTC, "How To Recognize and Avoid Phishing Scams". Published September 2022. Last checked November 3, 2026.
Note 64 FTC, "Government Grant Scams". Published August 2022. Last checked November 3, 2026.
Note 65 CFPB, "Medical Credit Cards and Financing Plans". Published May 4, 2023. Last checked November 3, 2026.
Note 66 8 U.S.C. 1182(a)(4), United States Code via GovInfo. Published 2024. Last checked November 3, 2026.
Note 67 Federal Register, DHS final rule "Public Charge Ground of Inadmissibility" (91 FR 45324, FR Doc. 2026-14539). Published July 20, 2026. Last checked November 3, 2026.
Note 68 USCIS Policy Manual, Volume 8, Part G, Chapter 7 (current as of October 27, 2026). Published October 27, 2026. Last checked November 3, 2026.