What is the difference between a medical bill and an EOB?

A medical bill is the statement from the doctor or hospital showing what you owe. An EOB, or Explanation of Benefits, is from your insurance company. It explains what they paid and what they didn’t, and why. The EOB is not a bill.

How do I know if my medical bill is correct?

You can compare the bill to your EOB from your insurance company. Check that the dates, services, and charges match. Also, make sure your personal information is correct.

CPT stands for Current Procedural Terminology. These are a set of numbers that medical providers use to describe the services and procedures they performed. You can look up these codes online to make sure they match the care you received.

What should I do if my bill and my EOB don't match?

First, contact the billing department of the healthcare provider. If they can’t help, call your insurance company and ask them to re-evaluate the claim.

I can't pay the full amount. What are my options?

You can ask the hospital’s billing department for a payment plan. Many hospitals offer interest-free plans to help you pay over time.

Can I get a discount on my medical bill?

It’s always worth asking! Many providers will offer a discount if you agree to pay a significant portion of the bill in full.

What if I can't afford the bill, even with a payment plan?

You can ask the provider’s billing department about financial assistance or charity care programs. These programs are often available for people who meet certain income guidelines.

Why is it important to keep notes?

Keeping notes helps you remember who you talked to, when you called, and what was discussed. This information can be very helpful if you need to follow up later.

Why do I have a bill if I have insurance?

Your insurance plan likely has a deductible, copay, or coinsurance that you are responsible for paying. These are the costs that your insurance doesn’t cover.

What's the first thing I should do when I get a medical bill?

The first step is to gather all your documents, including the bill, your EOB, and your insurance card. You need all of these to verify the bill’s accuracy.

Medical Bill Checklist - Wealth Explainers

Step 1: Gather Your Documents

Before you start, make sure you have the following information and documents on hand:

The medical bill or statement from the healthcare provider. ✓
Your **EOB (Explanation of Benefits)** statement from your insurance company. This is not a bill, but a summary of what they covered. ✓
Your insurance card and policy information. ✓
Any appointment notes or records you kept. ✓

Step 2: Verify the Bill's Accuracy

Go through the medical bill line by line and check for these common errors:

**Patient Information:** Is your name, address, and date of birth correct? ✓
**Provider Information:** Is the provider's name, address, and contact information correct? ✓
**Dates of Service:** Do the dates listed on the bill match the days you received care? ✓
**Services Provided:** Are the procedures and services listed accurate? For example, did you actually have an X-ray if one is listed? ✓
**Procedure Codes:** Check the **CPT (Current Procedural Terminology)** codes. Look them up online to confirm they match the services you received. ✓
**Double Billing:** Are you being charged twice for the same service? ✓
**Balance Owed:** Does the amount you are being asked to pay match your expected copay, coinsurance, or deductible, based on your EOB? ✓

Step 3: Compare the Bill to Your EOB

Now, match the medical bill to the EOB you received from your insurance company.

**Services Match:** Do the services and dates on the bill match the services and dates on your EOB? ✓
**Coverage & Payments:** Check that your insurance company paid the amount they said they would on the EOB. ✓
**Deductible/Coinsurance:** Does the "patient responsibility" amount on the EOB match the amount you are being billed by the provider? ✓
**Denied Claims:** If any claims were denied, review the reason. Was it for a non-covered service, a pre-authorization issue, or something else? ✓

Step 4: Contact the Right People

If you find an error or have questions, it's time to make some calls.

**Contact the Provider's Billing Department:** If you think there's a billing error (like a wrong date or code), call them first. Be polite, explain your concern, and have all your documents ready. Ask for an itemized bill if you don't have one. ✓
**Contact Your Insurance Company:** If the issue seems to be with how the claim was processed, call your insurance company. Ask them to re-evaluate the claim and explain any discrepancies between your EOB and the bill. ✓

Step 5: Negotiate and Plan Your Payment

If everything is accurate and you still owe a large amount, you may have options.

**Negotiate a Discount:** Ask the provider's billing department if they offer a discount for paying the bill in full. ✓
**Request a Payment Plan:** Ask if you can set up a manageable, interest-free payment plan. ✓
**Financial Assistance:** Inquire about financial assistance programs or charity care, especially if you meet certain income requirements. ✓

Remember to keep detailed notes of all your calls, including the date, time, who you spoke with, and what was discussed.

Step 1: Gather Your Documents

Step 2: Verify the Bill's Accuracy

Step 3: Compare the Bill to Your EOB

Step 4: Contact the Right People

Step 5: Negotiate and Plan Your Payment

Frequently Asked Questions (FAQs)