Med Bill Check

Compare a charge with Medicare's rate for one service. For when someone asks whether a charge is high or what Medicare pays, for example "I was charged $450 for a 99213 office visit in Texas, is that too high?" or "what does Medicare pay for an MRI of the knee?". Takes the billing code if they have it, otherwise the service in plain words as q. Returns Medicare's 2026 rate for the state (or the city's own pricing area when city is given) in medicare_2026, the amount providers typically billed in 2024, and how many times the Medicare rate the charge is. For care in a hospital, hospital_facility_2026 gives Medicare's national rate for the hospital's own facility fee and comparison.compared_with says what the charge was set against. Dental work has no Medicare rate and returns 404 with a pointer to a free dental cost source.

{
  "type": "object",
  "properties": {
    "code": {
      "type": "string",
      "description": "Five-character CPT or HCPCS code from the bill, like 99213, 73721 or G0121."
    },
    "q": {
      "type": "string",
      "description": "The service in plain words, used when there is no code, like \"knee MRI\" or \"ER visit\"."
    },
    "state": {
      "type": "string",
      "description": "US state name or two-letter code, like Texas or TX. Med Bill Check is for US bills; a UK place gets a short answer pointing to UK sources."
    },
    "charged": {
      "type": "number",
      "minimum": 1,
      "maximum": 5000000,
      "description": "The amount on the bill in US dollars, like 450."
    },
    "setting": {
      "type": "string",
      "enum": [
        "office",
        "facility"
      ],
      "description": "Setting: office (clinic, office, imaging center) or facility (hospital or surgery center). Leave out to use the usual setting."
    },
    "city": {
      "type": "string",
      "description": "City, for states where Medicare pays big cities differently, like Houston, Chicago, Miami or Los Angeles. Other places use the rest-of-state rate."
    },
    "billed_by": {
      "type": "string",
      "enum": [
        "hospital",
        "doctor"
      ],
      "description": "Whose bill the charge is on when the service was in a hospital: hospital (the hospital's own facility charge) or doctor (the doctor's or physician group's bill). Leave out if not known: the charge is then compared with both together."
    }
  },
  "required": [],
  "additionalProperties": false
}

Find billing codes and Medicare rates by plain words. For when someone describes a service but has no code, or asks what a code means, for example "what's the code for a colonoscopy?", "how much does Medicare pay for a chest x-ray in Ohio?" or "what is code 99214?". Returns up to eight matching codes with Medicare's typical allowed and billed amounts.

{
  "type": "object",
  "properties": {
    "q": {
      "type": "string",
      "description": "Plain words or a code, like \"hernia repair\" or 99214."
    },
    "state": {
      "type": "string",
      "description": "US state name or two-letter code."
    }
  },
  "required": [
    "q"
  ],
  "additionalProperties": false
}

Check several lines of an itemized bill at once. For when someone reads out or pastes several lines from an itemized bill, for example "my ER bill has 99284 for $2,500, 85025 twice for $120 and 36415 three times, does anything look off?". Takes the lines as code, optional x and units, then the amount. Returns each line against Medicare's rate, totals, and questions_to_ask: repeated codes, units above Medicare's automated daily limit, the highest visit levels, hospital clinic facility fees and charges far above what providers typically bill. Lines of a hospital bill (any bill with an ER visit on it, or setting=facility) are compared with Medicare's hospital outpatient rate plus the doctor's part; each such line says compared_with.

{
  "type": "object",
  "properties": {
    "lines": {
      "type": "string",
      "description": "Up to 15 bill lines separated by commas: code, then x and units if more than one, then the amount. Example: 99284:2500, 85025x2:120, 36415:45."
    },
    "state": {
      "type": "string",
      "description": "US state name or two-letter code."
    },
    "city": {
      "type": "string",
      "description": "City, for big cities with their own Medicare rates."
    },
    "setting": {
      "type": "string",
      "enum": [
        "office",
        "facility"
      ],
      "description": "Setting: office or facility. Leave out if not known."
    },
    "billed_by": {
      "type": "string",
      "enum": [
        "hospital",
        "doctor"
      ],
      "description": "Whose bill the charge is on when the service was in a hospital: hospital (the hospital's own facility charge) or doctor (the doctor's or physician group's bill). Leave out if not known: the charge is then compared with both together."
    }
  },
  "required": [
    "lines"
  ],
  "additionalProperties": false
}

Whether a hospital is nonprofit, for financial assistance. For requests like "is St. Luke's in Boise a nonprofit?" or "does this hospital have to offer charity care?". Returns how Medicare lists the hospital's ownership (nonprofit, government, for-profit), its city and main phone number, and what that means for financial assistance. Nonprofit hospitals must have a financial assistance policy.

{
  "type": "object",
  "properties": {
    "name": {
      "type": "string",
      "description": "Hospital name as on the bill, like St. Luke's Regional Medical Center."
    },
    "state": {
      "type": "string",
      "description": "US state name or two-letter code. Recommended, since many hospitals share names."
    },
    "city": {
      "type": "string",
      "description": "City, to pick between hospitals with the same name."
    }
  },
  "required": [
    "name"
  ],
  "additionalProperties": false
}

Draft a letter to a billing office for the user to send. For requests like "help me dispute this bill", "write a letter asking for an itemized bill", "can I ask for a discount?" or "how do I apply for charity care?". Returns a letter as plain text with [brackets] for anything not given, tips, and the user's No Surprises Act and Good Faith Estimate rights with official CMS links. It never sends anything.

{
  "type": "object",
  "properties": {
    "type": {
      "type": "string",
      "enum": [
        "itemized",
        "dispute",
        "discount",
        "assistance"
      ],
      "description": "Type: itemized (ask for an itemized bill), dispute (ask for a charge to be reviewed), discount (prompt-pay or self-pay discount), or assistance (financial assistance or charity care)."
    },
    "name": {
      "type": "string",
      "description": "Patient or account holder name."
    },
    "provider": {
      "type": "string",
      "description": "Hospital, clinic or provider name."
    },
    "account": {
      "type": "string",
      "description": "Account or invoice number on the bill."
    },
    "date": {
      "type": "string",
      "description": "Date of service."
    },
    "service": {
      "type": "string",
      "description": "The service in plain words."
    },
    "code": {
      "type": "string",
      "description": "Billing code of the charge. With amount, a dispute letter adds Medicare's benchmark (for a hospital charge, the hospital outpatient rate as well as the doctor's part)."
    },
    "amount": {
      "type": "number",
      "minimum": 1,
      "maximum": 5000000,
      "description": "Amount charged or balance due, in US dollars."
    },
    "state": {
      "type": "string",
      "description": "US state, used for the benchmark in a dispute letter."
    },
    "reason": {
      "type": "string",
      "description": "A sentence on what the user wants checked, for a dispute letter."
    },
    "insured": {
      "type": "string",
      "enum": [
        "yes",
        "no"
      ],
      "description": "Set to no if paying without insurance (self-pay), for a discount letter."
    },
    "setting": {
      "type": "string",
      "enum": [
        "office",
        "facility"
      ],
      "description": "Setting: office or facility (hospital or surgery center), for the benchmark in a dispute letter. ER visits and hospital clinic visits count as facility anyway."
    },
    "billed_by": {
      "type": "string",
      "enum": [
        "hospital",
        "doctor"
      ],
      "description": "Whose bill the charge is on when the service was in a hospital: hospital (the hospital's own facility charge) or doctor (the doctor's or physician group's bill). Leave out if not known: the charge is then compared with both together."
    }
  },
  "required": [
    "type"
  ],
  "additionalProperties": false
}