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Notice: The Fairness Foundation is only providing information. Such information is not legal advice. Legal advice can only come from a duly-licensed attorney in your State. The Fairness Foundation encourages you to consult with an attorney on legal matters as there are time limits that could adversely affect your legal rights.
Here is an example of UB-92 & UB-04 form
Request your UB-92 or UB-04 form from the hospital.
It's not always easy to get - we can help.
The medical diagnosis codes (DRG Code) on your UB-92
or UB-04 allow us to tell you what the government (Medicare) pays for the same care.
That's a starting point to determine a reasonable price.
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