Upload Your Bill (optional — or enter manually below)

📄

Drop your bill here or browse

PDF or JPG/PNG • Max 20MB

💡 Tip: For privacy, redact your name, address, and member ID before uploading. Our AI only needs the charges and CPT codes.

🔒 Encrypted upload — your data is never sold

Bill Details

Provider / Hospital Name

Date of Service

Your State *

⚠️ Required — your dispute package cites your state's consumer-protection laws.

Provider Type (improves letter accuracy)

Insurance Status (determines which rights apply)

Bill Status (affects letter type)

Total Amount Billed *

Amount Paid by Insurance (optional)

Your Responsibility *

Insurance Company (optional)

Enter individual charges from your bill. CPT codes are the 5-digit procedure codes — found in the description column of your itemized bill.

🔒 Your data is encrypted and never sold. Auto-deleted after 30 days.