Who it’s for and what people take away
Adults who get medical, dental, pharmacy or hospital bills, invoices or charges, or help a family member with theirs, whatever their confidence with paperwork.
By the end, people can:
- find the key parts of a medical bill or invoice: who it is from, the dates, each service, what has been paid and what is still owed.
- ask for an itemized bill and check it against what happened and any statement from an insurer or public program.
- spot common errors, such as duplicate charges or services not received, and question them politely in writing or by phone.
- ask about payment help, refunds or payment plans before paying, and find the official rules for where they live on the handout.
Before the session
- Read this whole kit and the country block for where you are teaching, and open each official link once so you know what the pages look like.
- Print one handout (with the right country block) and one worksheet per person, plus a few spares.
- Check the room has a projector or large screen, and test the slides on it before people arrive.
- Work through the made-up bill on the worksheet yourself first, so you know the three errors it contains: the blood test charged twice, an X-ray that never happened, and an X-ray dated the day after the visit.
- Bring a few highlighters so people can mark lines on the made-up bill.
- Ask the host whether anyone needs large print, an interpreter or extra time, and plan for it.
You will need
- Projector or large screen with the slides
- Printed handouts with the country block for where you are teaching
- Printed worksheets
- Pens and highlighters
- Flip chart or whiteboard and markers
Run sheet
60 minutes. Slide numbers refer to the deck.
Session timings| Starts | Length | What happens |
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| 0:00 | 5 min | Welcome and ground rulesSlides 1–2Introduce yourself and Moraph for Good. Explain that the session is general information, not medical, legal or financial advice, and that nobody will be asked to share their own bills or debts. Ask people not to bring real bills out in the room.Say: “Today is about reading the paperwork that comes after care. We’ll use a made-up bill, so nobody has to show anything of their own.” |
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| 0:05 | 8 min | Anatomy of a billSlides 3–5Walk through the parts of a bill or invoice: who it is from, account or reference number, dates, each line, codes, payments and adjustments, amount due and due date, and the contact for questions.Say: “Whether it’s a hospital bill, a dentist’s invoice or a pharmacy receipt, the same few things are on it. Once you know where they are, the rest is easier.” |
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| 0:13 | 7 min | Itemized bills and checking against statementsSlides 6–7Explain what an itemized bill is and why to ask for one. Explain that if an insurer or public program paid part, its statement should match the bill.Say: “A total on its own tells you very little. An itemized bill shows every line, so you can check each one.” |
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| 0:20 | 18 min | Activity: find the errorsSlides 8–9Run the activity in pairs. People read the made-up bill on the worksheet, highlight anything to question, and write it in the table. Walk around and help. Then go through the three errors with the room.Say: “There are at least three things on this bill worth asking about. See how many you can find.” |
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| 0:38 | 7 min | Questioning a charge and asking for helpSlides 10–12Go through how to question a charge, keep notes, and ask about financial help, refunds or a payment plan before paying. Stress asking before putting a bill on a credit card or taking a loan.Say: “The first bill is not always the last word. Ask questions before you pay, and ask what help exists.” |
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| 0:45 | 7 min | Here, in this countrySlides 13Hand out the handout and go through the country block: the charges people commonly meet here, the protections that exist and where to complain. Keep to what the handout says.Say: “Everything I say about this country comes from the official sources printed on your handout.” |
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| 0:52 | 8 min | Questions and closeSlides 14–15Take questions, using the common questions in this kit. Point people to the country block and the official sources for anything about their own bills.Say: “If I can’t answer something, the official sources on your handout can, and I would rather point you there than guess.” |
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Find the errors
18 minutes, using the worksheet.
- Put people in pairs and hand out the worksheet and highlighters.
- Explain the made-up situation: one visit to a clinic on 3 May, with a blood test. Nothing else happened.
- Pairs read the made-up bill on the worksheet line by line and highlight anything that doesn’t match the situation.
- For each highlighted line, they write in the table what looks wrong and the question they would ask the billing office.
- After about ten minutes, bring the room together and go through the bill line by line. The errors are: the blood test charged twice, an X-ray that never happened, and that X-ray dated 4 May, the day after the visit.
- Finish by working out together what the total should be once the errors are removed.
Questions for the room afterwards
- Which error was easiest to spot, and which was hardest?
- What would you say on the phone to the billing office about the X-ray?
- What would you write down during that call?
Take care
General information, never advice about one person’s situation, and nothing to sell.
- Never ask anyone to share a real bill, their debts or their income, and don’t read worksheets unless invited. If someone wants help with their own bill, point them to the billing office and the official sources on the handout.
- Never interpret a diagnosis or procedure code as medical information about someone. Say that the provider’s billing office can explain what a code means.
- Never tell anyone not to pay a bill or that a bill is wrong. Teach them how to ask questions and check.
- Never recommend a medical billing advocate, debt company, lender or credit card. Point to the official complaint and help routes on the handout.
- Don’t quote charges, fees or limits from memory. They change; the handout gives the official place to check.
Questions people ask
Do I have to pay a bill while I’m questioning it?
It depends on the country and the type of bill. Contact the billing office as soon as you can, say which lines you are questioning, and ask what happens to the amount while they check. The handout lists any official dispute process where you live.
What do the codes on my bill mean?
Many bills use codes for each service and sometimes for the reason for the visit. You don’t need to learn the codes; ask the billing office to explain any line you don’t recognize.
Can I ask for a discount or a payment plan?
You can always ask. Many hospitals, clinics and dentists offer financial help, discounts or payment plans, and some countries have public schemes for people on low incomes. Ask before you pay.
I paid and then found out I didn’t have to. Can I get it back?
Sometimes. Some schemes allow refunds if you claim within a time limit and kept your receipt. The country handout says what applies where you live.
Who do I complain to if the billing office won’t help?
The handout lists the official complaint routes where you live. Keep copies of the bill, your notes and any letters.
Where you are teaching
The rules differ by country. Teach the shared material from the slides, then use the block for the country you are in, and hand out that country’s sheet.
United States
- Surprise bills. The No Surprises Act protects most people with private insurance from unexpected out-of-network bills for emergency room visits, for non-emergency care related to a visit to an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services. Ground ambulances are generally not covered by these protections.
- Good faith estimates. If you don’t have or don’t use insurance, providers usually must give you a good faith estimate when you schedule care at least three business days ahead, or if you ask. If a provider’s bill is at least $400 more than its estimate, you may be able to dispute it, starting within 120 days of the first bill.
- During a dispute. While a bill is in the federal dispute process, the provider can’t send it to collections or threaten to, or collect late fees on it. There is a small, non-refundable fee to start a dispute.
- Complaints. The No Surprises Help Desk, on 1-800-985-3059, takes questions and complaints about surprise billing rules and can help in English, Spanish and many other languages.
- Hospital financial assistance. Nonprofit hospitals must have a written financial assistance policy offering free or discounted care to people who qualify, and their billing statements must include a notice about it with a phone number to call.
United Kingdom
- Prescription charges. In England, most working-age adults pay a charge for each item on an NHS prescription, though some groups get them free. NHS prescriptions in Scotland and Wales are free. If you pay for many items, a prescription prepayment certificate (PPC) covers them all for a set price.
- NHS dental charges. In England, NHS dental treatment is grouped into three bands, each with its own charge. If you need treatments from different bands, you pay only the highest band. The dental professional should tell you the cost before treatment starts.
- Refunds. If you pay a prescription charge and might be entitled to free prescriptions, ask for the FP57 receipt and refund form when you pay, as you can’t get one later. Refunds of other NHS charges, such as dental charges, use an HC5 form.
- Check before you claim free. Check you are entitled before ticking a box for free prescriptions or dental treatment. The NHSBSA exemption checker can confirm a certificate is valid. Wrongly claiming can lead to the charge plus a penalty charge.
- Help on a low income. The NHS Low Income Scheme can give full or partial help with prescription, dental, eye care and travel costs for people with a low income and limited savings.
Canada
- What you may be billed for. Provincial and territorial plans don’t insure everything. Services that are not insured include medical certificates for work, school or insurance, cosmetic services, and a preferred hospital room unless a physician prescribes it.
- Commonly not covered. Most public plans don’t pay for ambulances, so you may get a bill if you use one. Public plans usually don’t cover dental care, eye care or glasses, or prescription medicines outside hospital, though provinces give extra help to some groups.
- Hospital rooms and tests in Ontario. In Ontario, OHIP covers a standard hospital stay; if you want a private or semi-private room, you or private insurance pay some or all of the fee. Some specialized lab tests are only covered in certain circumstances.
- Out of province. A walk-in clinic might charge fees if you don’t live in that province or territory. Provincial plans cover residents who move to another province for up to three months, until they can register there.
- Ask first. Each province and territory decides what it covers, so check with your provincial or territorial ministry of health, and ask the clinic or hospital about any charge before the service.
Australia
- Gap fees. If a doctor doesn’t bulk bill, you pay the fee and Medicare pays back part of it, called the Medicare benefit or rebate. The difference you pay yourself is called the gap fee, co-payment or out-of-pocket cost. Ask about costs when you book.
- Claiming your rebate. Many practices can send your claim to Medicare when you pay, and the benefit goes into your bank account. Otherwise you can claim online through myGov or your Medicare online account, by post, or at a Services Australia service centre. Medicare general enquiries: 132 011.
- Medicare Safety Nets. If you spend a lot on out-of-hospital medical services in a calendar year, the Medicare Safety Nets give you more back. Singles qualify automatically; couples and families need to register, even if they share a Medicare card.
- Medicines. For PBS medicines you usually pay a co-payment, which changes each year. Medicines not on the PBS cost full price, and the PBS Safety Net lowers costs once you reach its yearly threshold.
- Ambulance bills. Medicare doesn’t cover ambulances. The Queensland and Tasmanian governments provide free ambulance trips; elsewhere you may be billed unless you have ambulance cover.