High Priority
Itemized Bill Request Letter
You can't fix what you can't see. Ask for the detailed itemized bill first. It's the fastest way to find mistakes and reduce what you owe.
Why This Letter Unlocks Savings
80% of bills have errors - you need details to spot them
Pauses collections while under review
Sets up all other appeals - needed for disputes
Required for assistance - charity care needs details
When to Use This Letter
Any hospital or provider bill that shows only a total amount or vague descriptions
Before disputing charges or applying for financial assistance
Within 7-14 days of receiving your first bill statement
When you see charges over $1,000 - always verify large amounts
What This Letter Requests
✓ Line-Item Details
- • CPT/HCPCS and revenue codes
- • Quantities, modifiers, and dates
- • Attending provider identifiers
- • Individual charge amounts
✓ Explanations & Delivery
- • Written explanation for bundled charges
- • Room and board breakdown by day
- • Supply and medication itemization
- • Email delivery or portal access
Customize Your Letter
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Your Letter
[Your Name] [Your Address] [City, State, ZIP Code] [Your Phone Number] [Your Email Address] 11/22/2025 [Provider/Hospital Name] [Provider Address] [City, State, ZIP Code] Re: Request for Itemized Bill - Patient: [Patient Name] Account/Bill Number: [Bill Number] Date of Service: [Date of Service] Dear Billing Department, I am writing to request a detailed itemized bill for the above-referenced account. The statement I received shows only summary charges totaling $[Total Amount], but I need complete line-item details to verify the accuracy of charges. Please provide the following information in writing: 1. **Complete Line-Item Breakdown:** - All individual charges with CPT/HCPCS procedure codes - Revenue codes for each service - Quantities and units for each charge - Modifiers applied to procedures - Date and time for each service provided 2. **Provider and Facility Details:** - Name and NPI number of attending physician(s) - Name and NPI number of facility - Any consulting or assistant providers involved 3. **Detailed Descriptions:** - Written explanation of any bundled or "package" charges - Breakdown of any room and board charges by day - Itemization of all supplies, medications, and equipment charges - Laboratory and diagnostic test details with codes 4. **Delivery Preferences:** - Please send via email as PDF attachment to: [Your Email] - Alternatively, make available through patient portal with notification **Important:** Please place a temporary hold on any collection activities while this request is being processed, as required under billing transparency regulations. I need this information to properly review the charges and determine next steps. I expect to receive this itemized bill within 14 business days as outlined in your billing practices. If you need additional information to process this request, please contact me immediately. Thank you for your prompt attention to this matter. Sincerely, [Your Signature] [Your Printed Name] Enclosures: Copy of original bill statement
Tips for Success
Before Sending:
- • Include a copy of your original bill statement
- • Send within 14 days of receiving the bill
- • Keep detailed records of all communications
- • Take photos of all documents before mailing
After Sending:
- • Send via certified mail with return receipt
- • Follow up if no response within 14 business days
- • Review itemized bill carefully for errors
- • Use details for charity care or dispute letters
What's Next After Getting Your Itemized Bill?
Disclaimer: This template is for educational purposes only and does not constitute legal advice. While this template follows best practices, every situation is different. For complex cases or significant amounts, consider consulting with CareRoute's Bill Defense team. CareRoute does not guarantee favorable outcomes from using this template.