Itemized bill request letter.
Ask the hospital for every charge, line by line, before you pay. The letter also asks for your billing records and the financial assistance policy, so you can check the bill properly.
Last updated .
When to use it
- Your bill shows only a few totals and you want to see every charge.
- Before you pay, negotiate or apply for financial assistance.
- A collector or the provider asks you to pay and you want to check what the amount is for.
The letter
Highlighted words in brackets are blanks. Replace each one with your own details.
[Today's date]
[Hospital or provider name] Billing Office [Billing office address]
Re: Request for an itemized bill Patient: [Patient's full name] Date of birth: [Patient's date of birth] Account number: [Account number on the bill] Date or dates of service: [Date or dates of service]
Dear Billing Office,
Please send me a complete itemized bill for the account above. For each charge, please show the date of service, the billing code (CPT, HCPCS or revenue code), a description in plain words, the quantity and the price.
Please also show every payment, adjustment and insurance payment on the account, and the balance that remains.
I am also requesting a copy of my billing and payment records for this account under my HIPAA right of access.
If you have a financial assistance policy, please send me a copy of it, its plain-language summary and the application.
Please do not send this account to a collection agency while I review the itemized bill. You can send everything to the address below, or by email to [Your email address].
Thank you,
[Your full name] [Your mailing address] [Your phone number]
How to send it
- Find the right address. Use the billing office's address for letters, which is printed on the bill or on the hospital's website. The address for payments is often a different one. Many hospitals also accept requests through the patient portal.
- Fill in every blank. Replace each highlighted word with your own details, then read the letter once more. If you would rather get everything by mail, delete the email sentence.
- Send it in a way you can prove. Certified mail with a return receipt, a portal message, or a fax with a confirmation page each give you a record. Keep a copy of the letter and of the proof that you sent it.
- Call as well. Tell the billing office that you have asked for an itemized bill in writing, and ask them to note it on your account.
- Know the time limits that apply to you.
- If you have Medicare, this letter is also your written request for an itemized statement of your Medicare services. If something on it looks wrong, ask Medicare to review it soon, because the law sets a time limit for that request Source 1. The provider must send you the statement within 30 days (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.
- If you live in Texas, a provider may not try to collect a bill until it has sent you an itemized bill with a plain-language description of each service or supply Source 2.
- Everywhere else, ask anyway. The HIPAA right of access covers the billing and payment records a provider keeps about you Source 3.
What happens next
When the itemized bill arrives, compare each line with your explanation of benefits if you have insurance. Look for charges that appear twice, services you did not get and charges your plan should have paid. Our guide to reading a medical bill explains the codes.
If you find a mistake, call the billing office, ask them to correct it and ask for the corrected bill in writing. Then ask about financial assistance and a payment plan before you pay anything. Our phone script has the words to use.
If nothing arrives, call the billing office, then send the letter again and keep both copies.
Next step
If you need help with your own situation, these can help:
LawHelp.org lists free legal aid near you.
Your state attorney general takes complaints about medical bills and debt collectors.
The CFPB complaint portal takes complaints about debt collectors and credit reports.
The hospital's financial assistance office can review your bill and tell you what it offers.
Sources
Note 1 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 2 Texas Legislature, SB 490 bill analysis. Published 2023. Not every state requires an itemized bill; these are the rights we could confirm. Last checked November 2, 2026.
Note 3 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.
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