Can I ask the insurance company to fix the code?

No — they can only process what's submitted. The correction has to come from the provider side.

The EOB says I'm "not responsible unless notified before the service." Does a generic intake form count as notice?

Generally that language refers to specific advance notice that a particular service wouldn't be covered — a generic "I'll pay whatever insurance doesn't" form is not that. If the denial stems from a provider error, put it in writing: "Per the EOB I'm not responsible for this balance; please submit a corrected claim."

How long does reprocessing take?

Commonly a few weeks after the corrected claim goes in. If a bill arrives mid-process, reference the pending correction in writing rather than paying.

The BillFix Guide · How we check

My bill is way above the Medicare rate. Is that an overcharge?

Short answer

Usually not, on its own. Medicare's published rate is the only price list that's public and consistent, so it's what almost everyone benchmarks against — including us. But commercial insurers pay well above it and hospitals list higher still, so "above the Medicare rate" describes very nearly every medical bill ever issued. What tells you something is actually wrong is how far above it a charge sits, and whether it's one line or every line on the page.

Published August 4, 2026

It's the first thing people find when they start checking a bill, and it's the easiest thing to misread. You look up what Medicare pays for a code, compare it to what you were charged, and the gap looks enormous. It usually is. That gap, by itself, is not evidence of an error.

Why the gap is normal. Medicare sets its rates by formula, and they sit at the bottom of the market. Commercial insurers negotiate their own rates on top of that — commonly somewhere between about 1.2 and 3 times Medicare, depending on the service, the region and how much leverage the hospital has. The "chargemaster" list price, which is what you see before any insurance adjustment, is higher again. None of that is hidden or improper. It's how the pricing works.

So a tool that flags every charge above the Medicare rate flags essentially every bill. That isn't a bill checker; it's a bill highlighter. And it does real harm, because a list of twenty "overcharges" that are all ordinary teaches you to ignore the one that isn't.

What we actually look for

Two things have to be true before we'll call a single charge an overcharge:

It's at least twice the Medicare rate. Below that, you're inside the range ordinary contracts occupy, and a billing office will say so.
It's at least $25 over. A $29 charge against a $10.56 reference is technically 2.75 times the rate — and it's eighteen dollars. A finding you wouldn't pick up the phone for makes the ones you would easier to dismiss.

Both, not either. They catch different mistakes: the multiple stops ordinary margin being called an error, and the dollar floor stops a big-sounding multiple on a trivial line becoming a finding worth nobody's time.

The pattern that hides from that test

There's a second way a bill goes wrong, and the per-charge test can't see it.

Consider a hospital bill with a hundred lines on it, each one marked up about 1.6 times the Medicare rate, each one twenty dollars over. Not a single line clears the bar above. Every one of them, on its own, is a charge you'd lose an argument about. Added together, they're two thousand dollars.

That's worth raising, and the argument you make is a different one. You're not saying any charge is wrong, because none of them individually is. You're saying: I understand one or two charges running high. Every charge on the bill, two thousand dollars above the published rate, is a different conversation — can we look at the overall level?

It's a weaker position than a single clear error, and it should be described that way. There's no one line to point at. But it's a real ask, and the mechanisms that answer it — financial assistance, a self-pay or prompt-pay rate, a payment plan — are the ones that move a whole-bill number anyway.

What the number we show you actually means

When we do show a figure, it's the gap between what you were billed and the Medicare rate. That is a ceiling, not a debt. Nobody settles a hospital bill at the Medicare rate — a realistic outcome lands somewhere above it. Treat the number as the outer edge of what you could argue for, and be pleasantly surprised rather than disappointed.

We'd rather tell you that than quietly imply you're owed the whole gap.

When we can't check at all

Medicare doesn't publish a rate for everything. Ground ambulance is the big one — there's no fee schedule for it in the way there is for an office visit — and many supply codes and facility charges have none either. When we can't price a line, we say we couldn't check it. We don't show you a green tick and call the bill accurate, because we didn't do the work that claim implies.

That distinction — we checked and it's fine versus we couldn't check — is worth insisting on wherever you get your bill reviewed.

If you want to be stricter, or less strict

The two thresholds are adjustable in the app under Settings. You can raise the multiple to 3x and the floor to $100 if you only want to hear about the egregious ones.

You can also lower the multiple to 1.5x, and we'll show you charges in that 1.5–2x band — but we'll label them plainly as charges most billing offices consider ordinary, and we'll leave them out of any letter we write for you. That isn't us hedging. A letter that argues a 1.6x charge invites a one-line refusal, and that refusal lands on every other point in the same letter. If you're going to make an argument, make the one you can win.

FAQ

Where do you get the Medicare rates?

From CMS's published fee schedules — the Physician Fee Schedule, the outpatient rates, and the clinical lab fee schedule — refreshed each year. They're public, and you can look up any code yourself.

Does being above the Medicare rate mean I was overcharged?

No. Commercial rates normally run above Medicare, so almost every bill is. It's the size of the gap, and whether it's one line or the whole bill, that tells you anything.

My bill was flagged. Does that mean I'll get money back?

Not automatically. A flagged charge is an argument worth making, not a decision that's been made. The figure we show is the gap to the Medicare rate, which is the most you could argue for rather than what you're likely to recover.

The Guide is general information, not legal or medical advice. Insurance rules vary by plan and state, and details change — check the dates on anything state-specific.