Patients rate billing just 1.75 out of 5 nationally, even as overall care scores top 3.79 in every state analyzed, according to Tellex Data Brief 002, released in September 2026.
Tellex analyzed 40 million patient accounts drawn from public reviews, forum threads, comments and staff posts. That produced 148 million structured observations across 16 aspects of care. The billing analysis covers 68,942 locations and 1,004,780 billing reviews.
Four things to know:
1. No state surpassed a 2 on a scale of 0-5.
2. California posts the highest billing score at 1.87 while scoring 4.09 on overall care.
3. Wyoming ranks lowest at 1.61.
4. Eighty-four percent of billing-related patient commentary is negative.
Patients describe providers and insurers pointing fingers at each other. “I call billing and they blame the insurance company and of course I call the insurance company and they blame the hospital,” one California reviewer wrote. An Ohio reviewer reported getting four separate bills for one service, ranging from $1,000 down to 55 cents.
Tellex found the problem is systemic, not the work of a few poor performers. Billing scores cluster at the bottom of the scale across the whole distribution, while overall satisfaction clusters near the top.
Scores are review-weighted and adjusted for contamination, with a minimum of 100 reviews per state and 30 per location.
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