Frequently asked questions

Hospitals, surgery centers, and doctor offices each set their own prices independently. There is no standard price for any procedure. A knee MRI can cost $400 at a freestanding imaging center and $2,500 at a hospital outpatient department — for the exact same scan. This variation exists because hospitals bundle facility fees, charge higher rates to insured patients, and use complex chargemaster pricing that bears little relation to actual costs.

We start with Medicare reimbursement rates — the amount the federal government pays for each procedure, broken down by work effort (Work RVU), practice expense (PE RVU), and malpractice cost (MP RVU). We adjust for your geographic area using CMS locality data (GPCI indexes), then apply a 140% multiplier to arrive at a fair cash price. This represents what facilities can profitably accept while eliminating the billing overhead that comes with insurance claims.

CPT (Current Procedural Terminology) codes are 5-digit numbers maintained by the American Medical Association that identify specific medical procedures and services. CPT 73721 is a knee MRI. CPT 99213 is a standard office visit. Every procedure has a CPT code, and knowing it lets you compare prices accurately across facilities. TrueCost lets you search by procedure name or CPT code.

Often, yes. Cash-pay patients skip the billing overhead that adds 15–25% to insured prices. Many facilities offer their lowest rates to cash patients because they get paid immediately with no claim denials, no collections risk, and no administrative cost. If you have a high-deductible plan and haven't met your deductible, you're already paying full price — at the inflated insurance-negotiated rate rather than the lower cash rate.

Start by requesting an itemized statement that lists every charge, CPT/HCPCS code, and quantity. The summary bill is not enough — only the itemized version shows enough detail to catch errors. Then compare each line against the Explanation of Benefits your insurer sent you — the EOB shows what your plan paid, what got discounted as a network adjustment, and what you actually owe. The bill should match the “patient responsibility” on the EOB. Look for duplicate charges, services you didn't receive, wrong service dates, and miscoded procedures. The AAFP and CMS bill guide both walk through the same review steps.

An Explanation of Benefits (EOB) is a statement your insurer sends after processing a claim. It is not a bill — most EOBs say “THIS IS NOT A BILL” right at the top. It shows what was billed, what your plan paid, what was adjusted as a network discount, and what you owe. The actual bill comes from the provider and should match the patient-responsibility line on the EOB. If they don't match, the bill is wrong. Always wait for the EOB before paying.

Under the No Surprises Act, if you are uninsured or self-paying, providers must give you a Good Faith Estimate of expected charges in writing before scheduled care. If your final bill comes in more than $400 above the estimate, you can dispute it through the federal Patient-Provider Dispute Resolution process. Always ask for the estimate in writing, save it, and reference it if the final bill is higher.

The No Surprises Act took effect in 2022. It bans surprise out-of-network bills for emergency care, air ambulance services, and most non-emergency care delivered at in-network facilities — including the classic case where an out-of-network anesthesiologist works on you at an in-network hospital. It also requires Good Faith Estimates for uninsured and self-pay patients. If you receive a surprise bill that you believe violates the law, file a complaint with CMS or call 1-800-985-3059.

Balance billing is when an out-of-network provider charges you the difference between their full price and what your insurer paid — leaving you on the hook for thousands of dollars. The No Surprises Act made balance billing illegal in most situations: emergency care, air ambulances, and most non-emergency care at in-network facilities. It remains legal at out-of-network facilities for non-emergency care only if you sign a written waiver acknowledging it. Never sign a waiver without understanding what you are agreeing to.

Five steps:

1. Request an itemized bill if you only have a summary.
2. Call the billing department and ask for a written explanation of any charge that looks wrong.
3. If a service was denied as “not covered,” call the insurer first — about half of denials are reversed on appeal per KFF data.
4. Send a written dispute letter to the provider's billing office, citing the specific charges and why they're wrong.
5. If the bill exceeded a Good Faith Estimate by more than $400, file a federal Patient-Provider Dispute Resolution claim.

Keep records of every call: date, name, and what was said. Documentation wins disputes.

All nonprofit hospitals are required by IRS rules to offer financial assistance — also called charity care — to patients who can't afford to pay. Eligibility is usually based on household income relative to the federal poverty level. Many hospitals provide free care up to 200% of the poverty level and discounted care up to 400%. Ask the billing office for the financial assistance application before paying, and ask if it's retroactive (most are). Dollar For helps patients apply at hospitals nationwide for free.

Recent rule changes made medical debt much less aggressive. Per the CFPB: medical debt under $500 cannot appear on your credit report, paid medical debt cannot appear at all, and unpaid medical debt of $500+ can only appear after one year. Collectors must verify the debt in writing if you request it within 30 days. They cannot threaten you, call you at work after you ask them not to, or contact you at unreasonable hours. If a collector violates the Fair Debt Collection Practices Act, file a complaint with the CFPB. Always request written verification before paying any medical collection.

Start by knowing the fair market price for your procedure — that's what TrueCost provides. Call the billing department and say: “I'm a cash-pay patient. I've researched fair market rates and Medicare pays $X for this procedure. I can pay $Y cash at time of service.” Most facilities will negotiate because guaranteed payment today is worth more than chasing insurance claims for months. TrueCost gives you word-for-word scripts with real dollar amounts for your area. The Patient Advocate Foundation also offers free case management for complex disputes.

Multiple studies, including research by Medical Billing Advocates of America, have found that roughly 80% of hospital bills contain errors. The average overcharge is approximately $1,300. Common errors include duplicate charges, charges for services not received, incorrect quantities, and unbundling (billing separately for items that should be grouped). Always request an itemized bill and review it carefully.

TrueCost is a healthcare pricing transparency platform. You can search any procedure, see fair cash prices by facility type and location, get negotiation scripts, upload bills for overcharge analysis, and chat with our AI cost navigator. During our beta period, all features are completely free — no credit card required.

We use the Medicare Physician Fee Schedule for baseline procedure rates, CMS Geographic Practice Cost Indexes (GPCI) for regional cost adjustments, and publicly available hospital price transparency data required by the No Surprises Act. Our pricing calculator uses 2026 RVU values and conversion factors published by CMS.