6 flags across 11 lines reviewed

Summary

Six potential issues were identified in this 11-line bill, including a possible duplicate E&M visit code, a duplicate lab panel charge, overlapping lab panel codes, a math discrepancy on the Albuterol line, a telehealth fee on an in-person visit, and an unitemized supplies charge. The patient is encouraged to bring these specific questions to the hospital billing department for clarification.

The dispute letter

A send-it-yourself letter to the billing department — you review, edit, and mail it as yourself.

[Your Name]
[Your Address]
[City, State, ZIP]
[Phone Number]
[Email Address]

[Date]

Billing Department
[Hospital Name]
[Hospital Address]
[City, State, ZIP]

Re: Billing Inquiry — Account Number RG-882041 | Date of Service: 03/14/2026

To Whom It May Concern,

I am writing to respectfully request a review of several charges on my bill for the date of service 03/14/2026, account number RG-882041. After carefully reviewing my statement, I have identified a number of items that I would like clarified before I proceed with payment. I am not disputing that I received care on this date; I am simply asking for an explanation of specific line items that appear inconsistent or unclear to me.

I would appreciate a written response addressing each of the following concerns:

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**1. Code 99284 — Emergency Department Visit, Level 4 — Quantity of 2 ($1,900.00)**

My bill shows code 99284 (Emergency dept visit, level 4) billed with a quantity of 2 on 03/14/2026, for a total charge of $1,900.00. My understanding is that a single emergency department visit on a single date of service would typically generate only one evaluation-and-management code. I am not aware of having had two separate ED encounters on this date. Could you please explain why this code appears with a quantity of 2? If this reflects a billing entry error, I would ask that it be reviewed and corrected as appropriate.

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**2. Code 80053 — Comprehensive Metabolic Panel — Appears Twice ($189.00 + $189.00)**

Code 80053 (Comprehensive metabolic panel) appears twice on my bill for 03/14/2026, each time with a charge of $189.00, for a combined total of $378.00. Both lines are identical in code, quantity, unit price, and charge amount. I would like to understand whether two separate comprehensive metabolic panels were actually ordered and performed on this date, or whether one of these lines is a duplicate billing entry. If it is a duplicate, I would ask that the bill be corrected accordingly.

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**3. Codes 80053 and 80048 — Comprehensive Metabolic Panel and Basic Metabolic Panel Billed Together ($189.00 + $119.00)**

In addition to the concern above, my bill also includes code 80048 (Basic metabolic panel, $119.00) on the same date as code 80053 (Comprehensive metabolic panel). It is my understanding that the components of a basic metabolic panel are generally included within a comprehensive metabolic panel. I would like to ask whether both panels were separately ordered and medically necessary on 03/14/2026, or whether these two charges overlap. I would appreciate confirmation that billing both on the same date is appropriate in my specific clinical circumstances.

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**4. Code J7613 — Albuterol, Inhalation Solution — Apparent Math Discrepancy ($76.00 billed vs. $57.00 calculated)**

The line for code J7613 (Albuterol, inhalation solution) shows a quantity of 3 and a unit price of $19.00. Multiplying those two figures gives $57.00; however, the charge column on my bill shows $76.00. I am unable to reconcile the quantity and unit price with the total amount billed. Could you please explain how the $76.00 charge was calculated, and if there is an error in either the quantity, the unit price, or the extended charge, I would ask that it be corrected.

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**5. Code Q3014 — Telehealth Originating Site Facility Fee ($78.00)**

My bill includes a charge under code Q3014 (Telehealth originating site facility fee) on 03/14/2026. However, my visit on that date was an in-person emergency department encounter. A telehealth originating site fee does not appear consistent with an in-person ED visit. I would like to ask whether any portion of my visit was actually conducted via telehealth, and if not, why this charge appears on my bill. If it was included in error, I would ask that it be reviewed and removed.

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**6. Code 99070 — Supplies and Materials Provided ($145.00)**

My bill includes a charge of $145.00 under code 99070 (Supplies and materials provided), with no further description of what specific supplies or materials are included. I am unable to verify from this description what was actually furnished during my visit. I would appreciate an itemized breakdown of the individual supplies and materials that make up this $145.00 charge so that I can confirm they were received during my care on 03/14/2026.

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In summary, I am respectfully requesting the following:

- A written, itemized explanation of each of the six items described above.
- A review of any lines that may reflect a billing error, duplicate entry, or mathematical discrepancy, and correction of the bill if warranted.
- An itemized list of the supplies included under code 99070.

I want to resolve this in good faith and I appreciate the time your billing team takes to look into these questions. I am holding payment on the disputed portions of this bill pending your response and review. Please feel free to contact me at the phone number or email address listed above if you need any additional information from me.

Thank you for your attention to this matter.

Sincerely,

[Your Name]
[Your Address]
[City, State, ZIP]
[Phone Number]
[Email Address]