I have a medical bill
My EOB and bill don't match. Which do I pay?
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Neither, yet. The EOB shows what your insurer says you owe; if the bill asks for more, call the provider's billing office and ask them to explain the difference before you pay.
What to do
- Put the bill next to the Explanation of Benefits (EOB), your insurer's statement of what it paid and what you owe. Check they match on provider, date and service.
- Compare the EOB's "patient responsibility" amount to the bill's total.
- Call the billing office and ask why the bill is higher. Sometimes the bill went out before the claim was processed, or a payment isn't posted yet.
- If they say the claim was denied or never arrived, ask your insurer for the claim status. Then ask the office for a corrected bill in writing.
What to say
My EOB shows I owe a different amount than your bill. Can you tell me the exact reason for the difference, and please send me a corrected bill in writing?
Have both documents in front of you, with the claim number and the date of service.
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 higher amount to make it go away. For covered services, an in-network provider generally can't bill you more than the share on your EOB.
Better done together
We’re here to help
When the EOB and the bill disagree, it is easy to pay the wrong amount. We go through both with you, find where they split, and help you ask the billing office the right questions before any money changes hands.
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.
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The rule behind it
An in-network provider has a contract with your insurer that sets the allowed amount, the most the plan counts for a covered service. Your EOB shows your share of that amount. For covered services, an in-network provider may not bill you for the difference above it; that is called balance billing.
Sources
- HealthCare.gov — Glossary: Balance billing
- HealthCare.gov — Glossary: Allowed amount
- Your Explanation of Benefits (EOB) and the provider's bill
- Your plan's Evidence of Coverage
Amanda Alcodia
Education, not medical, legal or insurance advice.
Useful next steps
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