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Medical Bill Audit & Dispute Plan

Delray Medical Center — Service Date: 02/07/2026

Confidential — Attorney-Client Privilege

Patient & Account Information

PatientMikhail Votek
Ref #025587731
Service DateFebruary 7, 2026
FacilityDelray Medical Center (Palm Beach Health Network / HCA)
Statement DateMarch 23, 2026
Total Charges$25,806.59
Insurance Adjustments-$17,917.42
Insurance Payment-$4,086.10
Outstanding Balance$3,803.07

Complete Charge Breakdown vs. Fair Market Value

CPT CodeDescriptionBilledMedicare RateMarkupFlag
DIAGNOSTIC / THERAPEUTIC IMAGING
70491CT Neck with Contrast$10,025.00$300–$60017x–33xEXCESSIVE
EMERGENCY ROOM
99285ER Visit Level 5 (Highest)$6,658.00$500–$8008x–13xUPCODING?
96361IV Hydration Additional Hour$313.59$30–$605x–10xHIGH
96374Therapeutic IV Push$686.00$50–$1007x–14xHIGH
LABORATORY SERVICES
85007Blood Smear Exam Diff$355.00$5–$1035x–71xReversed (-$355)
85025CBC with Auto Differential$1,094.00$11–$1573x–99xEXTREME
80053Comprehensive Metabolic Panel$2,761.00$14–$22125x–197xEXTREME
U0002COVID-19 Test$82.00$511.6xOK
87502Influenza Test (1st 2)$792.00$25–$5016x–32xEXCESSIVE
87651Strep A Amplified Probe$768.00$25–$5015x–31xEXCESSIVE
PHARMACY
J1100Dexamethasone 1mg Injection$120.00$1–$340x+HIGH
Q9967Contrast Dye (LOCM) 1ml$1,900.00$50–$15013x–38xEXCESSIVE
J7030Saline 0.9% 1L IV$607.00$1–$5 (cost)120x+EXTREME
TOTALS$25,806.59Fair value estimate: $1,200–$2,500

Key Audit Findings

Finding #1: Probable ER Level 5 Upcoding (CPT 99285) Level 5 ER visit ($6,658) requires an immediate significant threat to life or physiologic function. The services performed — CT neck, blood work, flu/strep/COVID testing, IV fluids, dexamethasone — are consistent with Level 3 (99283) or Level 4 (99284) evaluation of an upper respiratory infection with neck symptoms. Level 5 is reserved for major trauma, cardiac events, stroke, or sepsis. Downgrading to Level 3–4 would reduce this line item by $2,000–$4,000 before adjustments.
Finding #2: Laboratory Charges 73x–197x Medicare Rates A CBC ($1,094) at 99x Medicare and a Comprehensive Metabolic Panel ($2,761) at 197x Medicare are among the most extreme markups in this bill. These are routine blood tests that cost the lab $2–$5 each to perform. Even for a hospital chargemaster, these are outliers. The flu and strep tests are similarly inflated at 16x–32x.
Finding #3: Saline IV at $607 (120x+ Cost) A liter of normal saline (NaCl 0.9%) costs the hospital approximately $1–$5 wholesale. Charging $607 is a well-documented example of hospital price gouging that has been the subject of congressional hearings and media exposés. This is a strong negotiating point.
Finding #4: CT Contrast Dye at $1,900 Q9967 (Low Osmolar Contrast Medium) has a wholesale cost of $50–$150 per dose. The $1,900 charge represents a 13x–38x markup. This should be challenged.
Finding #5: Medical Necessity Verification Needed Were ALL these tests medically necessary for the presenting complaint? If the patient presented with sore throat/neck pain, a CT with contrast is a significant diagnostic step. We need the medical records to verify the clinical justification. If the CT was not clearly indicated, the entire $10,025 imaging charge becomes disputable.
Finding #6: Insurance Adjustment Pattern The insurance negotiated a 69% discount ($17,917 off $25,807). This is typical for HCA hospitals which set chargemaster rates 3–5x above what they actually expect to collect. The $4,086 insurance payment + $3,803 patient responsibility = $7,889 actual expected revenue, which is a 31% collection rate on gross charges. This confirms the gross charges are artificially inflated.

10-Step Dispute & Reduction Plan

1

Request Complete Medical Records

Call Delray Medical Center Health Information Management at (561) 498-4440 and request complete medical records for the 02/07/2026 ER visit including: physician notes, triage assessment, nursing notes, all orders, and discharge summary. Under HIPAA, they must provide within 30 days. Cost: up to $0.75/page or $6.50 for electronic.

Do this: Immediately (Week 1)
2

Request Itemized Bill with Revenue Codes

Call billing at 1(800)346-0775. Request a fully itemized bill showing: CPT codes, revenue codes, ICD-10 diagnosis codes, units, and the hospital's chargemaster description for each line. You have a legal right to this under the Affordable Care Act §2718 and Florida Statute §395.301.

Do this: Immediately (Week 1)
3

Dispute ER Level 5 Coding

Send a written dispute (template below) to billing arguing the ER visit should be downgraded from Level 5 (99285) to Level 3 or Level 4. Reference the AMA's CPT guidelines: Level 5 requires "high severity with immediate significant threat to life or physiologic function." The clinical presentation (respiratory/throat complaint with routine labs) does not meet this threshold.

Do this: Week 2 (after receiving medical records)
4

Challenge Medical Necessity of CT Neck

Review the medical records. If the presenting complaint was sore throat, fever, or upper respiratory symptoms, question whether a CT neck with IV contrast ($10,025) was medically necessary vs. a simpler examination. If the CT was ordered defensively (without clear clinical indication), file a medical necessity dispute with both the hospital and insurance.

Do this: Week 2–3 (after reviewing records)
5

File Insurance Appeal

Contact your insurance company's appeals department. Request a re-adjudication based on: (a) potential ER level upcoding, (b) medical necessity review of CT, (c) excessive lab charges. Ask specifically if the CT was pre-authorized. If it was performed without prior auth and the plan requires it, the hospital — not the patient — bears the cost.

Do this: Week 2–3
6

Check No Surprises Act Protections

Verify with your insurance whether ALL providers in this ER visit were in-network. If any physician (ER doctor, radiologist reading the CT) was out-of-network, the No Surprises Act (2022) prohibits balance billing for emergency services. You would owe only in-network cost-sharing amounts. Call your insurer and ask: "Were all providers for this ER visit in-network?"

Do this: Week 1–2
7

Request Financial Assistance Application

HCA Healthcare (Delray's parent company) has a Financial Assistance Policy (required under IRS §501(r) for non-profit hospitals; HCA voluntarily offers one). Request the application from billing. If household income qualifies (typically <400% Federal Poverty Level = ~$62,400 for individual, ~$129,600 for family of 4 in 2026), you may receive 25–100% discount on the patient responsibility amount.

Do this: Week 1 (in parallel with other steps)
8

Compare Against Hospital Price Transparency Data

Under the Hospital Price Transparency Rule (45 CFR §180), Delray Medical Center must publish machine-readable files of all standard charges. Visit their website or CMS's price transparency tool to compare the billed charges against their own published negotiated rates. If the billed amounts exceed the published rates, this is a powerful dispute lever.

Do this: Week 1–2
9

Negotiate Lump Sum Settlement

If steps 1–8 do not fully resolve the bill, call billing and offer a lump sum settlement. Script: "I've reviewed the charges and believe there are coding issues. I'd like to resolve this today. I can offer $950 as payment in full." Start at 25% of the balance ($950) and be willing to go up to 35–40% ($1,330–$1,520). Hospital billing departments have authority to accept settlements and often prefer immediate payment over collections risk.

Do this: Week 4–6 (after disputes are processed)
10

File Complaints if Unresolved

If the hospital refuses to engage, file formal complaints with:
• Florida Agency for Health Care Administration (AHCA) — ahca.myflorida.com — for price transparency and billing violations
• Florida Office of Insurance Regulation — for insurance claim handling issues
• CMS — for Hospital Price Transparency Rule violations
• Florida Attorney General — for unfair or deceptive trade practices
Mention in your dispute letter that you intend to file these complaints if the matter is not resolved. This often accelerates resolution.

Do this: Week 6+ (last resort)

Template Dispute Letter

Send via certified mail with return receipt. Keep a copy.

Date: [TODAY'S DATE] Delray Medical Center — Patient Financial Services PO BOX 1259, Dept #148905 Oaks, PA 19456 Re: Patient Account — Mikhail Votek Patient Ref: 025587731 Service Date: 02/07/2026 Outstanding Balance: $3,803.07 Dear Billing Department, I am writing to formally dispute the above-referenced account balance. After a careful review of the itemized statement dated 03/23/2026, I have identified the following concerns: 1. ER VISIT LEVEL CODING (CPT 99285 — $6,658.00) The visit has been coded as a Level 5 Emergency Department visit, which per AMA CPT guidelines requires "high severity with immediate significant threat to life or physiologic function." The services rendered — CT neck, routine blood work (CBC, CMP), respiratory pathogen testing (flu, strep, COVID), IV fluids, and dexamethasone — are consistent with evaluation of an upper respiratory or pharyngeal complaint, which typically meets Level 3 (99283) or Level 4 (99284) criteria. I request a clinical review and re-coding of this visit. 2. LABORATORY CHARGES SIGNIFICANTLY EXCEED FAIR MARKET VALUE The CBC (85025) was billed at $1,094 against a Medicare allowable rate of approximately $11–$15 (73x–99x markup). The Comprehensive Metabolic Panel (80053) was billed at $2,761 against a Medicare rate of $14–$22 (125x–197x markup). I request an explanation for these charges and adjustment to rates consistent with your published price transparency data as required under 45 CFR §180. 3. PHARMACY CHARGES Normal saline (J7030) was billed at $607 for a product with a wholesale acquisition cost under $5. Contrast dye (Q9967) was billed at $1,900 against a typical cost of $50–$150. These markups are unreasonable and should be adjusted. 4. MEDICAL NECESSITY I request documentation supporting the medical necessity of CT Neck with Contrast (70491, $10,025) for the presenting complaint. If this imaging was not clearly clinically indicated, I dispute this charge in its entirety. I request that you: (a) Conduct an internal audit of the ER visit level coding; (b) Adjust the laboratory and pharmacy charges to reflect fair market rates; (c) Provide documentation supporting medical necessity for all services; and (d) Recalculate the patient responsibility accordingly. Please note that I am also filing an appeal with my insurance carrier for re-adjudication of this claim. I request that collections activity on this account be suspended during the dispute resolution process, as is required under the Fair Debt Collection Practices Act for disputed debts. If this matter cannot be resolved, I intend to file complaints with the Florida Agency for Health Care Administration, the Florida Office of Insurance Regulation, and CMS regarding potential Hospital Price Transparency Rule violations. I look forward to your response within 30 days. Sincerely, _______________________________ [SIGNATURE] Mikhail Votek (or Authorized Representative) 7430 NW 25th Ter Boca Raton, FL 33496-2057 Encl: Copy of statement dated 03/23/2026

Realistic Outcome Targets

$0–$500

Best Case: Financial Assistance Approval

If Mikhail qualifies for HCA's financial assistance program, the entire balance could be waived or reduced to a nominal amount.

$800–$1,500

Good Case: Successful Dispute + Lump Sum

ER visit downgraded from Level 5 to Level 3/4, insurance re-adjudicates, then negotiate lump sum settlement on remaining balance at 30–40%.

$1,500–$2,200

Likely Case: Partial Adjustment + Negotiation

Hospital makes partial adjustments on lab/pharmacy charges, insurance covers some additional amount, negotiate remainder down.

$3,803

Worst Case: No Action Taken

If no dispute is filed, the full $3,803.07 will be due. After 90–120 days, the account may be sent to collections which can damage credit.

Action Timeline

WeekActionContact
Week 1Request medical records + itemized bill + financial assistance app + check No Surprises ActHospital: (800)346-0775
Records: (561)498-4440
Insurance: [your plan]
Week 2Review records. Send dispute letter (certified mail). File insurance appeal.Mail to: PO Box 1259, Oaks PA 19456
Week 3Compare published price transparency data. Follow up with insurance on appeal status.Hospital website + CMS tool
Week 4–5Follow up on dispute letter response. Submit financial assistance app if applicable.Hospital billing
Week 6If unresolved: negotiate lump sum OR file regulatory complaints.AHCA, FL OIR, CMS

Key Contacts

Delray Medical Center Billing1(800)346-0775
Delray Medical Records(561)498-4440
Grievance AddressPO Box 660873, Dallas TX 75266-0873
Billing AddressPO Box 1259, Dept #148905, Oaks PA 19456
FL AHCA (Complaints)ahca.myflorida.com • (888)419-3456
CMS Price Transparencycms.gov/hospital-price-transparency

Prepared March 30, 2026 • Confidential Medical Bill Audit

This analysis is for informational purposes and does not constitute legal or medical advice.