Sanford Health Bill Dispute — How to Appeal and Reduce Your Bill

Receiving a large bill from Sanford Health can feel overwhelming — especially if you're recovering from a serious illness, a difficult pregnancy, or a complex procedure. Sanford Health is one of the largest rural health systems in the United States, serving patients across the Dakotas, Minnesota, Iowa, and beyond. Like many large nonprofit health systems, patients commonly report receiving bills that are difficult to understand, contain unexpected charges, or don't reflect the financial assistance they were promised. This guide walks you through exactly what to do — step by step — to dispute your Sanford Health bill, reduce what you owe, and protect yourself financially.

What Are Common Billing Issues Patients Report at Sanford Health?

Sanford Health operates dozens of hospitals and hundreds of clinics across a wide geographic footprint. Billing across a system this large creates real opportunities for error. Billing auditors and patient advocates frequently cite error rates in complex hospital bills as high as 80%, though estimates vary by facility type and billing complexity.

Patients who have sought help disputing Sanford Health bills commonly report issues including:

• Duplicate charges — the same service, medication, or supply billed more than once
• Upcoding — billing for a more expensive procedure or visit level than what was actually performed
• Unbundling — separating services that should be billed together under a single code, inflating the total
• Charges for services not rendered — items appearing on the bill that patients have no record of receiving
• Incorrect insurance adjustments — billing the patient for amounts that should have been written off as contractual adjustments with their insurer
• Financial assistance not applied — patients who qualified for Sanford's financial assistance program but were billed at full rates

None of these are unique to Sanford Health — they are widely reported patterns across large health systems — but they are documented starting points for any dispute you bring to their billing department.

How Do I Get an Itemized Bill from Sanford Health?

Before you can dispute anything, you need to see exactly what you're being charged for. A summary bill — often just a single line total — tells you almost nothing. You need an itemized statement that lists every charge individually, including procedure codes (CPT codes), revenue codes, and descriptions.

Under state laws and CMS Conditions of Participation, you generally have the right to request an itemized bill from any hospital. Here's how to get yours from Sanford Health:

1. Call Sanford Health Patient Billing directly. The billing number appears on your statement. Ask specifically for a "complete itemized bill" or "itemized statement with CPT and revenue codes." Note the name of the representative and the date you called.
2. Submit your request in writing. Follow up your phone call with a written request sent via certified mail or through Sanford's patient portal (MyChart) to create a documented record.
3. Request your medical records simultaneously. You can request your records at any time — Sanford Health is required to respond within 30 days (with a possible 30-day extension). Cross-referencing your itemized bill against your medical records is one of the most effective ways to identify charges for services that were not actually documented in your care.

Once you have the itemized bill in hand, go line by line. Flag anything you don't recognize, any charge that appears more than once, and any procedure you don't remember undergoing. This document becomes the foundation of your dispute.

What Is the Official Dispute Process at Sanford Health?

Sanford Health, like all hospitals operating under CMS Conditions of Participation (42 CFR § 482.13), is required to maintain a formal patient grievance process. This is your structured pathway to a written response.

Follow these steps in order:

1. Contact Sanford Patient Billing first. For straightforward billing errors — a duplicate charge, an obvious insurance processing mistake — the billing department may resolve it immediately. Document everything in writing.
2. File a formal written dispute. If the billing department doesn't resolve your concern, submit a written dispute letter. Your letter should identify each disputed charge by line item and code, explain the basis for your dispute (error, no service rendered, incorrect adjustment, etc.), and request a written response. Send it certified mail, return receipt requested, or through the patient portal with a saved confirmation.
3. Escalate to the Patient Grievance Process. If billing doesn't satisfy your dispute, request to file a formal grievance with Sanford's Patient Relations or Patient Experience department. This triggers the hospital's formal grievance process, which requires a written response.
4. Request a billing review or audit. For large or complex bills, you can specifically request that your account be reviewed by a billing supervisor or compliance officer. Mentioning that you are reviewing charges for coding accuracy — particularly upcoding or unbundling — often prompts a more careful review.

Keep copies of every letter, every response, every portal message, and every call log entry throughout this process. If you need to escalate externally, this documentation is essential.

Does Sanford Health Have a Financial Assistance or Charity Care Program?

Yes. Sanford Health is a nonprofit health system with federal tax-exempt status. Under IRS Section 501(r), nonprofit hospitals with 501(c)(3) status are required to have a financial assistance policy (FAP) and must make reasonable efforts to determine whether patients qualify before pursuing extraordinary collection actions such as lawsuits, wage garnishment, or credit reporting.

Key things to know about Sanford Health's financial assistance:

• Income-based sliding scale. Sanford Health's financial assistance program generally provides discounts on a sliding scale based on household income relative to the Federal Poverty Level (FPL). Patients who fall below certain thresholds may qualify for free or significantly reduced care.
• You can apply retroactively. If you've already received care and received a bill, you can still apply for financial assistance. Billing auditors commonly find that patients who were never screened — or who were screened incorrectly — qualify for assistance they were never offered.
• Request the Financial Assistance Policy in writing. Under 501(r), Sanford Health is required to make its FAP publicly available. Ask for the full written policy and the application form. This is not a discretionary courtesy — it is a federal requirement for maintaining their tax-exempt status.
• Application materials must be provided at no charge. You should not be charged to apply for financial assistance.

If you believe you may qualify, submit the application immediately — even if a bill is already in collections — and note the submission date in writing.

When Should You Escalate Beyond Sanford Health's Internal Process?

Internal dispute processes have limits. If Sanford Health's billing department has not resolved your dispute, has denied your financial assistance application without adequate explanation, or has taken collection action you believe is improper, it's time to escalate.

Your Insurance Company

If the dispute involves how your insurer processed the claim — incorrect benefit application, a denied claim you believe should be covered — file a formal appeal with your insurance company. Request their internal appeal process in writing, and if that fails, request an external independent review. Federal law gives you the right to external review for most denial types under the ACA.

The No Surprises Act

If you received emergency care or were treated by an out-of-network provider at an in-network facility without proper advance notice, the No Surprises Act may limit what you can be charged. For emergency services, NSA protections are absolute — no consent form can waive them. If you believe you were improperly billed for out-of-network services, you can file a complaint at cms.gov/nosurprises. Note that the federal Independent Dispute Resolution (IDR) process under the NSA is a process between your insurer and the provider — patients do not initiate it directly.

State Insurance Commissioner and Attorney General

If your insurer has wrongly denied coverage, file a complaint with your state's Department of Insurance. If you believe Sanford Health has engaged in deceptive billing practices, your state Attorney General's consumer protection division accepts complaints. North Dakota, South Dakota, and Minnesota each have active consumer protection offices.

CMS and HHS

If you believe Sanford Health has violated its 501(r) obligations — for example, by taking extraordinary collection actions without first screening you for financial assistance — you can file a complaint with CMS or the IRS (Form 13909 for tax-exempt organization complaints).

A Patient Advocate or Medical Billing Advocate

For bills over $5,000 or disputes involving denied financial assistance, a professional patient advocate or medical billing auditor can identify errors and negotiate on your behalf. Many work on a contingency or flat-fee basis.