How do I draft a letter disputing billing for a medical event or do I wait for collections before getting legal advice?

Question

When I was admitted for treatment at the ER, I indicated that I had no insurance and wanted the minimum of care necessary to resolve the immediate issue. Instead it appears that they ordered a battery of very expensive tests that have no medical necessity. At the conclusion of my last conversation with a hospital rep, she indicated that the ER physician made his decisions for diagnostic testing based on my symptoms at the time and all who had reviewed my chart agreed. I requested a point-by-point listing of which complaints related to which tests and diagnostics in writing. What I got was a letter with a general recap of our telephone conversations and yet another denial. How do I get them to commit in writing to why I am being charged for these tests?

Tim Akpinar · Answer

No, you probably don't want to wait for collections because you could be one step closer to a default judgment if anything slips up. Additionally, based on how aggressive any collection efforts would be, attorney fees could be thrown into the mix. A North Carolina attorney could advise you best in terms of your options here, and what might be the most cost-effective and prudent course of action. You raise a good point about medical necessity, but that defense usually avails itself to matters involving insurance. Without insurance as a private pay, the burden would be on you to demonstrate a lack of medical necessity. And retaining medical experts to do that could be prohibitive. Maybe a brief consult with a North Carolina attorney familiar with collection matters could help you avert bigger problems by confronting the matter right now before it grows out of hand. Good luck 
 
Tim Akpinar

Q: How do I draft a letter disputing billing for a medical event or do I wait for collections before getting legal advice?