How to fight backBillSherpa · Updated 2026

What Happens After You Send a Dispute Letter — The Hospital's 30-Day Obligation

You've sent your dispute letter certified mail. The clock is now running. Here's what hospitals are legally required to do after receiving a billing dispute, what a proper response looks like, and exactly what to do when they don't respond — or when they respond by simply restating the original bill.

What happens in the first 30 days

After receiving your dispute letter, the hospital's billing department should:

1. Log the dispute as received
2. Pull your account and the relevant medical records
3. Route the dispute to a billing compliance reviewer or supervisor
4. Compare the disputed charges against the documentation
5. Determine whether the charge is supported or whether a correction is warranted
6. Respond to you in writing with their determination

Most state laws and insurance regulations require healthcare providers to respond to written billing disputes within 30 days. If your dispute involved insurance, your insurer also has obligations — insurers must respond to appeals within 30 days for non-urgent claims and 72 hours for urgent claims under federal law.

What a proper response looks like

A genuine response to your dispute should include:

• Acknowledgment that your dispute was received and reviewed
• A clear statement of their determination — either that the charge is correct (with the documentation that supports it) or that an error occurred and will be corrected
• If correcting: a corrected itemized statement showing the adjusted balance
• If denying your dispute: the specific documentation they're relying on and the reason they believe the charge is correct

What an inadequate response looks like

Many hospitals respond with form letters that don't actually address the dispute. These inadequate responses include:

• A letter saying "we have reviewed your account and confirm the balance is correct" with no supporting documentation
• A new statement simply reissuing the same charges
• No response at all
• A phone call (not in writing) claiming the charges are correct

An inadequate response is grounds for escalation. You are entitled to a substantive written response that addresses the specific errors you identified and provides the documentation that supports the charges you disputed.

The escalation path when they don't respond properly

1. Day 30 — no response or inadequate response. Send a follow-up certified letter stating that your dispute remains unresolved, that their response was inadequate, and that you are escalating. Give them 10 additional business days.
2. File a complaint with your state insurance commissioner. If insurance was involved, this is your most powerful lever. Insurance commissioners regulate insurer and provider billing conduct. A formal complaint creates a regulatory record. Most commissioners have online complaint portals — use them.
3. File a complaint with your state health department. State health departments oversee hospital licensing. A complaint here carries weight — hospitals don't want compliance investigations on their records.
4. File a complaint with CMS. If the No Surprises Act was violated, file at cms.gov/nosurprises. If Medicare or Medicaid was billed and you believe fraud occurred, file with the HHS OIG at oig.hhs.gov.
5. Contact your insurer directly. If insurance processed the claim incorrectly, ask your insurer to contact the provider directly to correct the billing. Insurers have contractual relationships with providers that give them leverage you don't have.

What to do if they correct the error

When the hospital agrees with your dispute and issues a corrected statement:

• Get the correction in writing — a corrected itemized statement or a letter confirming the charge has been removed
• Confirm the corrected amount with your insurer if insurance was involved
• If you already paid the disputed amount, request a refund in writing — hospitals are legally required to issue refunds for overpayments
• Keep all documentation (your dispute letter, their response, corrected statement) for at least 3 years