Hospital Billing Error Dispute Log (Free PDF)
Track hospital billing errors, calls, and appeals in a clear PDF you can share with billing, insurance, or legal aid.
Published November 24, 2025
Surprise hospital bills and coding errors are common—and hard to fight without documentation. This free dispute log helps you track each charge, who you spoke with, and what happened so you can push back with confidence.
When to use this
- You received a hospital bill that looks wrong or much higher than expected.
- Your insurance denied a claim and you need to track appeals and calls.
- You’re working with a patient advocate or legal aid and want a clean summary.
How to do it (fast)
- Enter your patient and insurance information at the top of the form.
- Add each questionable charge with service date, amount, and error type.
- Record every call or email about the bill, including who you spoke with and what they said.
- Download a PDF to bring to billing, insurance, or a medical debt advocate.
Why this helps
- Contesting medical bills is much easier with a single, organized log.
- Shows patterns of errors or inconsistent explanations over time.
- Runs privately in your browser—no signup and no uploads required.
Related tools
- Medical Bill Negotiation Log PDF
- Medical Expense Reimbursement Log PDF
- Insurance Denial Appeal Log PDF
Not legal advice. Courts set their own rules. Keep your original records.