Worked Example

The $7,656 ER Bill With a $4,212 Error

An emergency room bill arrived 18 months late with a 30-day collections threat. Here is the full report IGOTCHU produced for it.

This is a complete IGOTCHU report produced from a real document during product testing. It is a worked example of what you receive, not a customer story.

The Situation

An ER visit in November 2024. Insurance paid its share. Then, 18 months later, a statement arrives demanding $7,656 within 30 days, with a collections warning attached. The customer's worry was the collections threat. The analysis found something bigger: the same CT scan, CPT code 74178 at $4,212, billed twice. The report below shows where they stand, the decision reached for them, and every letter ready to send.

The report, exactly as delivered

IGOTCHU provides research, document analysis, and general information only. We are not attorneys and nothing here is legal advice.

A $7,656 bill showing up 18 months after the ER visit, with a 30-day collections threat attached, is designed to make you pay fast without looking. Look first. This bill has a $4,212 charge that appears twice.

Strong position

The same CT scan code (74178) is billed twice at $4,212 each, insurance already processed this claim, and a nonprofit hospital has legal limits on how fast it can send you to collections.

Riverside Methodist is part of OhioHealth, a nonprofit system, which means IRS 501(r) financial assistance and collection-timing rules apply. A visible likely duplicate charge plus an Anthem EOB you can check against this balance gives you concrete grounds to dispute before paying anything.

The Decision

Dispute before paying

Do not pay this bill as written. Dispute it in writing within the 30-day window, starting with the apparent duplicate $4,212 CT charge and a demand that the balance be reconciled against your Anthem EOB.

1.One of the two $4,212 CT scan charges (CPT 74178) is removed, unless the hospital produces radiology records proving two separate scans were performed and Anthem processed both.

2.The patient balance is recalculated to exactly match the patient responsibility shown on your Anthem BCBS Explanation of Benefits for the November 3, 2024 visit.

3.The account is placed on hold from collections, in writing, while the billing review is open.

4.You are screened for financial assistance under the hospital's 501(r) financial assistance policy and Ohio HCAP before any collection activity.

5.Any remaining balance after corrections is settled through negotiation or an interest-free payment plan, only after you receive a corrected written statement.

The Bigger Risk

You asked about: You are mostly worried about the account going to collections.

The bigger risk is paying some or all of $7,656 out of fear when the bill likely contains a $4,212 duplicate and may not match what your Anthem EOB says you owe.

Collections is a slow, regulated process with multiple protections, including 501(r) limits on nonprofit hospitals and credit bureau policies that delay medical debt reporting. Overpaying is instant and very hard to claw back. Dispute first, get the corrected number, and the collections threat shrinks along with the balance.

Pre-filled from your document: Riverside Methodist Hospital · Billing Department, PO Box 182559, Columbus, OH 43218 · (614) 555-0166

Send This First

Itemized Bill Request and Billing Review Letter

June 1, 2026

Riverside Methodist Hospital
Billing Department
PO Box 182559
Columbus, OH 43218

RE: Patient Account RMH-2291847, Date of Service November 3, 2024, Statement Dated May 28, 2026

Dear Billing Department,

I received your statement dated May 28, 2026 showing a patient balance of $7,656.00 for an emergency department visit that took place on November 3, 2024. This is the first statement I have received for this visit, and it arrived roughly 18 months after the date of service, so I want to make sure I understand it before anything moves forward.

My request is this: please send me a complete itemized bill with all CPT codes, open a billing review of this account, and place the account on hold from collections while that review is pending.

Three things on the statement prompted this request. First, CPT code 74178, CT Scan Abdomen with contrast, appears twice at $4,212.00 each. I would like documentation showing whether two separate scans were actually performed and whether Anthem BCBS processed both. Second, I would like the balance reconciled against my Anthem BCBS Explanation of Benefits, since the statement shows an insurance payment of $3,180.00 and an adjustment of $1,925.00 and I need to confirm the $7,656.00 balance matches what my plan says I owe. Third, I understand that as a nonprofit hospital, Riverside Methodist maintains a financial assistance policy under IRS Section 501(r). Please send me a copy of that policy and an application, and please confirm I will be screened for assistance before any extraordinary collection action is taken.

I am not refusing to pay what I genuinely owe. I simply need an accurate, documented bill first, and I believe a review will resolve this quickly. Please confirm in writing within 14 days that the account is on hold and the review is open.

Thank you for your help.

Sincerely,
[YOUR NAME]
[YOUR ADDRESS]
Account: RMH-2291847

Phone Script

Phone Call Script

WHO TO ASK FOR: Patient Financial Services, then ask for a billing supervisor if the first person cannot place a hold or open a review.
NUMBER: (614) 555-0166

OPENING (word for word): "Hi, my name is [YOUR NAME], calling about account RMH-2291847, a statement dated May 28, 2026 for an ER visit on November 3, 2024. This is the first bill I have received for that visit and I need help understanding it before the 30-day deadline on the statement. Can you help me with that?"

Then: "I see CPT code 74178, the CT scan of the abdomen with contrast, listed twice at $4,212 each. Can you tell me whether two separate scans were performed, and whether Anthem processed both? I would also like a full itemized bill mailed to me, and I am asking that the account be held from collections while this is reviewed."

IF THEY SAY 'The charges are correct as billed':
"I understand that is what the system shows. I am asking for the documentation behind it, the itemized bill and the radiology records showing two scans. Until I can see that, can you note the account as disputed and place a hold? I want to resolve this, I just need to verify it first."

IF THEY SAY 'We cannot stop the collections referral':
"I understand you may not control that directly. Since Riverside Methodist is a nonprofit hospital, my understanding is that federal rules under IRS Section 501(r) require the hospital to make reasonable efforts to screen patients for financial assistance before collection action. Can you transfer me to a supervisor who can place a hold, or tell me who handles financial assistance applications? I would also like to start that application today."

IF THEY OFFER A PARTIAL SOLUTION (for example, a payment plan on the full $7,656):
Do not accept a payment plan yet. Say: "I appreciate that, and I may want a plan later, but I cannot agree to pay a balance that includes a charge I am disputing. Once the duplicate question is resolved and the balance matches my Anthem EOB, I am happy to talk about how to pay what is actually owed." Accept a hold plus an open review. That is the win on this call.

CLOSING: "Thank you, [their name]. Just to confirm, you are sending the itemized bill to my address on file, the account is noted as disputed with a hold through [date], and the reference number for this call is [number]. Could you send me written confirmation of that?" After hanging up, write down the date, time, the person's name, and exactly what was agreed.

Follow-Up Letter

14-Day Follow-Up Letter

June 15, 2026

Riverside Methodist Hospital
Billing Department
PO Box 182559
Columbus, OH 43218

RE: Patient Account RMH-2291847, Date of Service November 3, 2024, Follow-Up to My Letter of June 1, 2026

Dear Billing Department,

On June 1, 2026 I wrote requesting three things on this account: a complete itemized bill with CPT codes, a billing review of the duplicate CPT 74178 charge of $4,212.00 that appears twice on the May 28, 2026 statement, and a written hold on collections while the review is pending. I have not yet received a response, so I am following up in good faith.

I want to resolve this, and I believe the review will make the path forward clear for both of us. The statement says the account will be referred to collections if unpaid within 30 days, which falls on June 27, 2026. Because this account is in active dispute, I am asking for written confirmation by June 24, 2026 that the review is open and the account is on hold.

If I have not heard from you by that date, my next step will be to ask the Ohio Attorney General's Consumer Protection Section to help facilitate a resolution, which I would prefer to avoid because I think we can sort this out directly.

Thank you for your attention to this.

Sincerely,
[YOUR NAME]
[YOUR ADDRESS]
Account: RMH-2291847

Escalation Letter

June 26, 2026

Director of Patient Financial Services
Riverside Methodist Hospital
PO Box 182559
Columbus, OH 43218

RE: Patient Account RMH-2291847, Date of Service November 3, 2024, Unresolved Billing Dispute

Dear Director,

I am writing to you directly because my attempts to resolve this account through the billing department have not received a response. Here is the timeline. The statement dated May 28, 2026 was the first bill I received for a November 3, 2024 emergency visit, showing a balance of $7,656.00 and a 30-day collections deadline. On June 1, 2026 I sent a written request for an itemized bill, a review of CPT code 74178, which is billed twice at $4,212.00 each, reconciliation against my Anthem BCBS Explanation of Benefits, and a collections hold. On June 15, 2026 I sent a follow-up asking for written confirmation by June 24, 2026. I have received no substantive response.

My ask has not changed. Please open a billing review, correct or document the duplicate CT charge, reconcile the balance against my Anthem EOB, send me the hospital's financial assistance policy and application as required of nonprofit hospitals under IRS Section 501(r), and hold the account from collections while this is pending.

Because the stated collections deadline has now arrived with the dispute unresolved, I am required to protect myself by copying the Ohio Attorney General's Consumer Protection Section on this letter. I would much rather resolve this directly with your office, and a corrected statement and written hold would end the matter from my side.

I can be reached at the address below and will respond promptly.

Sincerely,
[YOUR NAME]
[YOUR ADDRESS]
Account: RMH-2291847

CC: Ohio Attorney General, Consumer Protection Section

Second CT scan charge (74178)Out of line

Yours

$4,212 (billed twice)

Standard

$0 if only one scan performed

Unless records prove two separate scans, the second line should not exist at all.

CT Abdomen w/contrast (74178)Out of line

Yours

$4,212 per scan

Standard

$450 to $1,500 benchmark

Medicare pays roughly $450 to $700 for this study and typical negotiated or cash prices run under $1,500, these are benchmarks and vary by region.

ED Visit Level 4 (99284)Out of line

Yours

$2,847

Standard

$600 to $1,300 benchmark

A Level 4 ER facility charge is legitimate for a visit involving CT imaging, but the price is well above typical insurer-negotiated rates.

IV Infusion 1st hour (96365)Out of line

Yours

$891

Standard

$150 to $300 benchmark

Charging for the infusion itself is standard practice, the price is the problem, not the line item.

Comprehensive Metabolic PanelOut of line

Yours

$412

Standard

$15 to $80 benchmark

Medicare reimburses this panel around $15 and cash labs charge under $80, this is a chargemaster price.

Ondansetron 4mgOut of line

Yours

$187

Standard

$1 to $15 benchmark

Generic ondansetron costs pennies per dose, hospital pharmacy markup at this scale is common and negotiable.

Billing an ER visit at Level 4Standard

YOURS

Level 4 of 5

STANDARD

Level 4 typical for CT workup

The coding level itself appears appropriate for a visit with contrast CT imaging, do not spend energy fighting the level.

Today

Before You Respond

After They Reply

Got a medical bill that doesn't add up?

Most medical bills contain errors. Most hospitals negotiate. Find out what's actually in yours.

Get Yours Now — $25