I have a medical bill
Is my medical bill right? How to check it
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Compare the bill to your insurer's Explanation of Benefits (EOB) line by line. If the amounts differ, or a line does not match what happened, ask the billing office to explain before you pay.
What to do
- Ask the billing office for an itemized bill with the billing codes (CPT or HCPCS codes for services, revenue codes for hospital charges).
- Find the Explanation of Benefits (EOB) for the same date of service, the statement from your insurer that shows what the plan paid and what you owe.
- Compare the EOB's 'patient responsibility' amount to the total on the bill; the two should match.
- Check each line against what you remember: the dates, the number of items, and anything you did not receive.
- Call the billing office about anything that does not add up, and write down the date, the name of the person, and what they said.
What to say
I'd like to request an itemized bill with the billing codes. I'm not refusing to pay; I'm asking for a bill I can verify.
Say it calmly to the billing office on the bill, and ask them to note in your file that you called today.
What to watch out for
This is a sensitive stepSmall details here can change the outcome, and some mistakes are hard to undo. We highly recommend a free 15-minute call with us before you decide.
Paying the bill before the EOB arrives. Once you have paid, getting money back for an error is much harder than getting the bill corrected first.
Better done together
We’re here to help
Checking a bill is a skill, and it gets quicker every time. The first time, it helps to do it next to someone who reads these every day.
We go through your bill and your EOB with you line by line, show you what to look for, and point out what is easy to miss: a charge listed twice, a code that doesn't match the visit, a balance that should have gone to insurance. After that, you can check the next one yourself.
Every situation is different, and these are sensitive moments, so we look at yours with care. We often see what others miss, and we never take commissions from insurance companies: the only thing we are working for is what is right for you.
Free · 15 minutes · No pressure
The rule behind it
Your insurer's Explanation of Benefits (EOB) is not a bill. It shows the total charges, what your plan covers, and what you should owe, and CMS advises comparing your bill against it. Your bill should not be higher than the amount the EOB says you owe. You can ask the provider for an itemized bill. For people on Medicare, federal law requires the provider to send one within 30 days of a written request (42 U.S.C. 1395b-7). Hospitals must also post their standard charges online under the federal hospital price transparency rule (45 CFR Part 180), so you can compare what you were charged.
Sources
- CMS — How to read a health insurance explanation of benefits
- CMS — How to read your medical bill (compare it with your EOB)
- CMS — Hospital price transparency
- 42 U.S.C. 1395b-7 — Itemized statement for Medicare items and services
- 45 CFR Part 180 — hospital price transparency
Amanda Alcodia
Education, not medical, legal or insurance advice.
Useful next steps
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