Short answer: pick Resolve if your bill is over about $15,000, involves insurance denials, or you want a person making the calls. Pick BillKarma if the bill is under that, the problem is errors or prices far above Medicare, and you'd rather pay $29–$149 flat than 10%–25% of your savings.

We make BillKarma, so read this with that in mind. Every fact about Resolve below comes from Resolve's own website, checked in November 2026, and we say plainly where Resolve is the better choice.

1. Side by side

ResolveBillKarma
How it worksA dedicated advocate reviews the bill, calls the hospital and insurer, and negotiatesChecks every line against Medicare rates, writes a dispute letter, sends it to billing and follows up automatically
Bills it takesDebts of $5,000 or more; insured, uninsured or in collectionsHospital and facility bills of any size
Fee25% of savings ($5k–$15k bills), 10% (over $15k)Flat: $29 (under $1k), $49 ($1k–$5k), $99 ($5k–$20k), $149 (over $20k)
Minimum feeLower of $1,000 or half the savings; $2,500 on bills over $15kNone beyond the flat fee
Upfront$249 or $499 deposit, applied to the feeThe flat fee
If nothing is savedDeposit refundedFee refunded if not reduced within 45 days
Phone negotiationYesNo, written only
Insurance appealsYes, when appropriateNo
Charity care applicationsYesFree eligibility check; certified mailing $9
Typical timelineAbout 4 months on averageLetter sent right away; follow-ups on days 7, 14, 30, 45
Find out what's wrong first. Upload your bill to BillKarma — the check is free and shows which charges are duplicates or far above Medicare, whichever service you use next.

2. What each costs on real bill sizes

Have a bill like this? Check it free.

Upload it and see every charge next to what Medicare pays for the same code, with duplicates and overlapping tests flagged.

Check my bill free

These use each company's published prices. The savings figures are examples to show the math, not predictions.

BillExample savingsResolve feeBillKarma fee
$2,400 ER visit$900Not offered (under $5,000)$49
$8,000 outpatient surgery$3,000$1,000 (minimum fee: lower of $1,000 or half of $3,000)$99
$12,000 surgery$4,000$1,000 (25%)$99
$40,000 inpatient stay$15,000$2,500 (minimum fee)$149

The fee gap is large. The real question is whether a human advocate would win a bigger reduction than a written dispute. On a big, messy bill, often yes. On a bill with a clear duplicate or an obvious overcharge, usually not. For every major service's prices, see what medical bill negotiation services cost. Weighing Goodbill instead? Read BillKarma vs Goodbill.

3. When Resolve is the better choice

  • Large bills. On bills over about $15,000, a 10% fee with a person on the phone can be worth it.
  • Insurance problems. Denied or underpaid claims need an appeal to the insurer. Resolve handles that; BillKarma doesn't.
  • You want someone to handle everything. A named advocate who makes calls and does the paperwork.
  • Credit report worries. Resolve says it works to keep medical bills off credit reports.
Know your hospital before you call. Check our hospital directory — the billing phone number, financial assistance policy and how far its prices run above Medicare.

4. When BillKarma is the better choice

  • Bills under $5,000. Resolve doesn't list them; BillKarma's fee is $29 or $49.
  • Clear errors. Duplicate lines, wrong quantities or services you didn't receive. A written dispute fixes these without a negotiator.
  • You want a paper trail. Every request is in writing and dated.
  • You want to keep the savings. A flat fee means a $3,000 reduction costs you $99, not $1,000.

5. When you need neither

If your income is under the hospital's limit and it's a nonprofit hospital, apply for financial assistance first. It can erase the bill for free, and the nonprofit Dollar For will help you apply at no cost. You can also dispute the bill yourself with our free letters.

Frequently asked questions

What is the main difference between BillKarma and Resolve?

Resolve assigns a human advocate who negotiates by phone and charges a share of the savings. BillKarma checks the bill against Medicare rates and sends a written dispute for a flat fee, with automatic follow-ups.

Does Resolve take small medical bills?

Resolve's How We Work page lists debts of $5,000 or more. For smaller bills, a written dispute, a financial assistance application or doing it yourself is usually the better route.

Which is cheaper, BillKarma or Resolve?

BillKarma, on almost every bill: $29 to $149 flat. Resolve charges 25% of savings on bills of $5,000 to $15,000 and 10% above that, with minimum fees. Resolve does more for that price, including phone negotiation and insurance appeals.

Can Resolve help with insurance denials?

Yes. Resolve says it appeals denied or underpaid claims when appropriate. BillKarma's dispute service doesn't; see how to appeal an insurance denial.

What happens if neither lowers my bill?

Resolve refunds its deposit in full if it finds no savings. BillKarma refunds its flat fee in full if the bill isn't reduced within 45 days.

Sources