For millions of Americans, medical bills are more than just a paperwork headache—they’re a leading source of personal debt and financial stress. But what if the core issue isn’t about clerical errors or insurance mix-ups? What if the problem is the price itself?

At Patient Fairness, we believe patients should understand what drives the outrageous cost of care, and how they can fight back. The truth is, most problem medical bills come down to one thing: excessive, unjustified pricing. Let’s break it down.

The Hidden Reality of Billed Charges

First, it’s essential to understand that the prices you see on a medical bill—called “billed charges”—are rarely what providers expect to be paid. Hospitals and doctors use inflated charges as a starting point for negotiations with, or to maximize out-of-network payments from, insurance plans. But these prices are also passed on to uninsured or self-pay patients.

In 2018, hospitals reported charging, on average, 417% of what it cost them to deliver the services. That means services for which a hospital bills $1,000 likely cost the hospital just $240 to render. For-profit hospitals mark up prices even more, on average by 671% of cost. These figures come directly from reports hospitals file with the Centers for Medicare & Medicaid Services (CMS).

When you see a bill that feels outrageous, it probably is. That’s why we at Patient Fairness advises against using billed charges as any sort of baseline for determining a fair price in a medical bill dispute.

The Problem with Insurance Prices

Even if you’re insured, you’re not necessarily protected. Insurance companies often negotiate discounted rates with providers, but these Insurance Prices are usually just a percentage off those already-inflated billed charges. So while it might look like you’re getting a good deal from your health plan’s negotiated prices, these prices are often still far more than what you consider to be fair based on the provider’s cost or the Medicare price.

What’s worse, Insurance Prices have been climbing much faster than general inflation. Since 2000, prices paid by health plans to hospitals have more than tripled, far outpacing increases in wages or cost of living.

This is why we also caution against using Insurance Prices to determine what’s fair. They may be discounted, but they may not be reasonable, especially when disputing a medical bill based on what’s fair to the patient.

The Real Issue: No Agreement on Price

Beyond the numbers, there’s a bigger legal and ethical concern. In contract law, a valid agreement requires a “meeting of the minds.” That means both parties must understand and agree on the terms, including pricing.

With medical bills, patients rarely know what something will cost until they receive the bill weeks later. No prices were disclosed. No consent to the specific prices was given. Yet providers act as if the patient agreed to pay whatever is billed.

This lack of shared understanding is why so many medical bills are fundamentally unfair—and why disputing a medical bill is reasonable.

Why Disputing Price Matters More Than Finding Errors

A lot of advice about medical bills focuses on checking for duplicate charges or coding errors. That’s not bad advice, but it often misses the bigger opportunity: challenging the inflated price itself.

Let’s say you’re charged $600 for 12 loaves of bread at $50 each. You notice only 10 loaves were rung up, and you get 2 loaves ($100) taken off for a new bill of $500. That’s good, but now imagine arguing that $6 per loaf is a fair price instead. That would drop your bill to $72, a savings of $528 from the original bill, and $428 in savings vs. correcting the number of loaves from 12 to 10.

The same principle applies when disputing a medical bill. Focusing on pricing can lead to much deeper reductions than searching for line item errors. This is exactly why our platform emphasizes price disputes as a key strategy.

What Is a Fair Price?

If billed charges and insurance prices are unreliable, what should you use?

At Patient Fairness, we rely on two reliable benchmarks in our Medical Bill Price Review:

• Medicare Fee Schedule: What the federal government pays for the same service
  
  
• Hospital Cost Data: What the provider reports it actually costs to render the service

Both are far more transparent and grounded in reality than the arbitrary prices patients usually see. These benchmarks form the foundation when disputing a medical bill through our service.

Take Control with Patient Fairness

The idea that patients should blindly pay whatever they’re charged is a harmful myth. When hospitals set prices four to ten times their cost, and insurance is ineffective at keeping them in check, it’s up to patients to protect themselves.

At Patient Fairness, we empower you to do just that.

• The Problem Medical Bill Assessment to identify potential reasons to dispute your particular medical bill.
• A professionally crafted Letter of Dispute that cites the specific issues on which you are basing your dispute, including price concerns, legal protections, and other sound arguments.
• The Medical Bill Price Review to evaluate the prices charged.
• Evaluation of Proposals to settle the dispute, both proposals from the provider, and proposals you consider making to the provider.
• A professional letter of dispute, grounded in cost benchmarks
• Ongoing support through resolution.
• Fair and affordable prices for Patient Fairness’s services, starting at just $49.
  
  

You don’t have to accept the sticker shock. You can push back—intelligently, confidently, and with evidence on your side.

Ready to start disputing a medical bill? Open a case and take the free Problem Medical Bill Assessment to take the first step toward a fair resolution.