To get reimbursed through Start Health, you’ll need to submit an itemized bill (also known as a “standard claim form”) from your provider. This document includes the medical codes we need to properly reimburse you for eligible expenses. Getting this from your provider is usually simple, but if you run into roadblocks, you have rights, and we’re here to help.
Whenever possible, we recommend calling your provider in advance to let them know you’ll need an itemized bill for your visit. Before you leave the office, request the itemized statement and show your Start Health member card so they know exactly what you need.
Why You Need an Itemized Bill
An itemized bill gives a clear breakdown of:
- The service(s) you received
- The CPT and DX codes associated with each service
- The provider who delivered care
- The charge for each service
Providing these details allows us to issue your reimbursement quickly and correctly.
What Counts as an Itemized Bill?
An itemized bill must include key details such as CPT codes, diagnosis (DX) codes, service descriptions, and pricing. Most providers can generate this easily, but you can also request one of the two standard claim forms used industry-wide which always contain the information Start Health needs for reimbursement:
- CMS-1500 (HCFA form): For doctor visits and professional services
- UB-04: For facility-based care (hospitals, surgical centers, urgent care, etc.)
If your provider uses an online portal (such as MyChart), you may also find these documents under Visit Summary, Billing, or Documents. If you can download it from there, you can upload it directly to your Start Health Member Portal.
Note: We cannot accept handwritten receipts or credit card statements. The itemized bill must come directly from your provider, or, alternatively, you can use our Start Health Member Reimbursement Form.
Your Rights as a Patient
Under federal law, specifically the No Surprises Act, you have the right to receive the following as a self-pay patient:
- A clear, itemized bill for any medical service you receive
- A description of each charge
- The codes associated with the services
- A copy delivered to you by email, paper mail, or both
You are legally entitled to this information, even if the billing office seems hesitant or says, “We don’t usually provide that for self-pay patients.” They are required to give it to you.
How to Ask For an Itemized Bill
Here’s a simple script you can use with your provider or their billing office:
“Hello, I need an itemized bill for my visit. I am a self-pay patient on a reimbursement plan, and my plan requires that I provide CPT codes, diagnosis codes, and service descriptions.”
If you feel like you’re not getting anywhere, try saying:
“Under the No Surprises Act, I have the right to receive a fully itemized bill for my records. Can you please connect me with someone who can provide that?”
Tips When Dealing with a Difficult Provider
Billing departments can be challenging to navigate. Long wait times, multiple transfers, overseas teams, and vague answers are all common experiences. This is largely due to the way the healthcare system is structured, where pricing has historically been unclear or inaccessible to patients. If you face resistance, stay firm, polite, and persistent. We recommend:
- Keeping a record of your call. This helps if you need to follow up or escalate.
- Asking for the name and title of everyone you speak with. It creates accountability and makes future follow-ups easier.
- Requesting to speak with a supervisor.
- Requesting to speak with a U.S.-based representative if you’re having trouble communicating or not getting clear answers.
- Clearly stating that you need an itemized bill with CPT and diagnosis (DX) codes.
- Mentioning the No Surprises Act, which reinforces your right to receive a detailed bill.
- Confirming how the bill will be sent. Ask for both an emailed and a mailed copy, and verify that they have the correct contact information.
Having Trouble? We Can Help.
If you’ve tried and still can’t get an itemized bill, please reach out to Start Health. We can contact your provider’s billing team and advocate on your behalf.
