Understanding Medical Bills and Explanation of Benefits (EOBs)

Red flags and urgency levels

• UrgentSeek care today

  A bill threatening collections while your appeal or dispute is still open.

• SoonMake an appointment within days to a couple of weeks

  Charges for services or dates you do not recognize, or duplicate line items.

• SoonMake an appointment within days to a couple of weeks

  Out-of-network charges for care you received at an in-network facility.

• MonitorKeep track and mention it at your next visit

  A bill that matches the EOB and reflects your expected deductible or coinsurance.

• An EOB is not a bill; it shows charges, what the plan allowed and paid, and patient responsibility. The provider bill should not ask you to pay more than the EOB patient-responsibility balance for that claim.
• Federal surprise-billing (No Surprises Act) protections generally cover emergency services, certain non-emergency services at in-network hospitals, hospital outpatient departments, and ambulatory surgical centers, and air ambulance — not every out-of-network bill.
• Nonprofit (tax-exempt) hospitals must have a financial assistance policy and put a conspicuous written notice on billing statements (phone and website). Other facilities may still offer aid — ask even if you do not see a notice.
• Federal NSA protections generally do not cover ground ambulance. For some allowed non-emergency or post-stabilization services, a notice-and-consent form can waive certain protections (not for emergency services or certain ancillary providers).
• Request an itemized bill with billing codes and compare each line and your share to the EOB for the same date of service.
• Uninsured or self-pay patients may get a good-faith estimate; if the bill is $400 or more above the estimate, a patient-provider dispute resolution process may apply.
• Good-faith estimate and patient-provider dispute resolution are for people who did not have or did not use insurance. If you used insurance, that dispute process generally does not apply — use an NSA complaint and/or your plan’s appeal process instead.

1. 1

   Request an itemized bill with billing codes from the provider.

2. 2

   Match every line to your EOB for the same date of service.

3. 3

   Call the provider’s billing office about coding or billing errors, and your insurer about coverage decisions — they are different problems.

4. 4

   Ask about financial assistance, prompt-pay discounts, and payment plans before paying in full; look for any financial assistance notice on the statement; ask to pause collections while an FAP application is pending when applicable.

5. 5

   Keep dated notes of every call: who you spoke with, what was agreed, and a reference number.

6. 6

   Dispute or hold fork: If you are uninsured or self-pay and the bill is $400 or more above a good-faith estimate, ask about patient-provider dispute resolution (generally within about 120 days of the initial bill; there may be a filing fee; collections are generally paused during the dispute). If you used insurance, that process generally does not apply — use an NSA complaint and/or your plan’s appeal process. CMS No Surprises Help Desk: 1-800-985-3059.

7. 7

   If you are uninsured or self-pay and care is scheduled, ask for a good-faith estimate before the visit.

• “Can I get an itemized bill with the billing codes used?”
• “Was this service billed as in-network, and at which facility?”
• “Do you offer financial assistance or a sliding scale, and how do I apply?”
• “Can this balance be placed on hold while I dispute it with my insurer?”
• “Who at your office handles coding corrections?”
• “Can you provide a good-faith estimate for upcoming care?”

• No Surprises Act: Protections Against Surprise Medical BillsCenters for Medicare & Medicaid Services
• How to read an EOBCenters for Medicare & Medicaid Services
• How to read your medical billCenters for Medicare & Medicaid Services
• Check your medical bill for errorsCenters for Medicare & Medicaid Services
• Apply for medical bill financial assistanceCenters for Medicare & Medicaid Services
• Dispute a medical billCenters for Medicare & Medicaid Services
• Know your Medical Bill of RightsCenters for Medicare & Medicaid Services
• Financial Assistance Policy and Emergency Medical Care Policy — Section 501(r)(4)Internal Revenue Service

• Appealing an insurance denial
• Getting your medical records
• How to prepare for a doctor's appointment