Navigating Confusing Medical Bills

What your bill is and what it is not

An Explanation of Benefits is not a bill

If you have insurance, the plan sends an Explanation of Benefits after a claim processes. It shows what was billed, what the plan allowed, what the plan paid, and what you may owe. It is a helpful record to compare against any later bill, but it is not a request for payment.

A Medicare Summary Notice is not a bill

If you have Original Medicare, you receive a Medicare Summary Notice about every four months. It lists services and what Medicare paid. Use it to check claims and costs before paying any provider bill.

First steps when a bill arrives

1. Pause before paying. Give yourself time to review the bill, your Explanation of Benefits or Medicare Summary Notice, and any estimates you received. CMS provides plain language guides on reading both EOBs and medical bills.
2. Gather your documents. Collect the bill, your EOB or MSN, any Good Faith Estimate you requested or received, and discharge paperwork if applicable.
3. Ask for an itemized bill. Request a detailed list that shows each service, date, quantity, and code. This makes it easier to spot errors like duplicate charges or services you did not receive, and to compare against your insurance documents.
4. Compare allowed amounts. Match each line on the itemized bill to the EOB or MSN. Confirm that billed services, dates, and quantities align with what your plan allowed.
5. Check network status and your rights. For most emergency care and for certain care at an in network facility, federal rules limit out of network balance billing.
6. Look at any Good Faith Estimate. If you are uninsured or not using insurance and your final bill is at least four hundred dollars more than the estimate, you may be able to dispute it.

How to compare your documents

Match key fields

Look at patient name, dates of service, place of service, provider names, and billed codes. On the EOB or MSN, check the allowed amount, plan payment, and what the provider says you owe. Differences here often explain most surprises.

Verify the services

Use the itemized bill to confirm that each service or supply listed actually happened. Pay special attention to quantities, facility fees, observation charges, and high cost items like imaging or infusions. If something does not look right, call the billing office and your plan using the reference numbers on the documents. CMS offers practical “how to read” guidance for both bills and EOBs.

Common issues you can catch early

1. Services you did not receive or wrong dates.
2. Duplicate charges for the same item or test.
3. Wrong quantity of a drug, supply, or therapy session.
4. Out of network charges applied when you used an in network facility for services covered by federal protections.
5. A final bill that does not match a Good Faith Estimate by at least four hundred dollars when you did not use insurance.

Your rights that can lower or erase a bill

Surprise billing protections

The No Surprises Act protects people with most group or individual plans from many out of network surprise bills. Protections generally apply to emergency care, certain non emergency services from out of network clinicians at an in network hospital or ambulatory surgical center, and air ambulance services.

Good Faith Estimate and disputes

If you did not use insurance, you can request a Good Faith Estimate before scheduled care. If the final bill is at least four hundred dollars more than the estimate, you may be able to use the patient provider dispute process.

Important exception for ground ambulances

Federal surprise billing protections do not generally cover ground ambulance services, although some states have their own rules. Check your state resources if you get a ground ambulance bill.

If a provider or plan is not following the rules

You can submit a complaint to federal agencies through the CMS medical bill rights pages.

If the bill still looks wrong, take these steps

1. Call your health plan. Ask for a claim review and have your EOB, itemized bill, and any estimate in front of you.
2. Call the provider billing office. Ask them to put the account on hold while they investigate and to send a corrected bill if needed.
3. Appeal in Medicare or with your plan. If Medicare or your Medicare Advantage plan denies coverage or applies costs you believe are wrong, you can file an appeal. Instructions are on your MSN or in your plan materials, and Medicare provides step by step guidance.
4. Keep good records. Save copies of bills, EOBs, MSNs, estimates, letters, and notes from calls. For tax purposes, the IRS generally advises keeping records that support deductions for three years.

Financial help if you cannot pay

If the bill is from a nonprofit hospital, federal tax rules require a written Financial Assistance Policy and reasonable efforts to determine eligibility before extraordinary collection actions. Ask for a copy of the policy and the application. Hospitals must also limit charges for people who qualify.

How an Understood Care advocate helps by video

On a video call, you can share your bill and we review it with you line by line. Together, we decide whether it is something you truly need to pay. Many statements are generated by computer and some are sent in error, so people sometimes pay when they do not have to. We focus on keeping your money in your pocket and out of a provider account when payment is not appropriate. If a correction or appeal is needed, we help you contact the billing office and your plan, request an itemized bill, and organize the paperwork so that everything is done correctly and in a way that fits your needs.

Related Understood Care resources you can use today
• Analyze Bills support page
• Appointments and care coordination
• Get started with an advocate

What to bring to your video review

1. The bill and any prior statements.
2. Your EOB or Medicare Summary Notice.
3. Any Good Faith Estimate.
4. Notes about what happened during your visit or stay.
5. Your insurance card and plan contact information.

When to seek urgent help

Call your plan and your provider quickly if you see billing for services you did not receive, identity mix ups, or collections threats while an appeal or dispute is open. If you are a Medicare beneficiary and a denial affects access to ongoing care or needed equipment, start the appeal process promptly and ask your advocate to help you gather supporting documents.

Understanding Medical Bills and Insurance Notices: Frequently Asked Questions

• Is an Explanation of Benefits the same as a bill?
  No. An Explanation of Benefits, often called an EOB, is not a bill. It is a statement from your health plan that shows what was billed, what the plan allowed, what the plan paid, and what the plan thinks you may owe. It is meant to help you understand how a claim was processed and to give you something to compare against any bill you later receive from a doctor or hospital. You do not pay an EOB itself.
• Is a Medicare Summary Notice a bill?
  No. A Medicare Summary Notice, or MSN, is also not a bill. If you have Original Medicare, you receive an MSN about every four months. It lists the services Medicare processed in that period and shows what Medicare paid and what it believes you may owe. You use it to check claims and costs before paying any bill from a provider.
• What is the first thing I should do when a medical bill arrives?
  Pause before paying. Give yourself time to review the bill carefully. Gather the bill, your EOB or Medicare Summary Notice, any Good Faith Estimate you requested or received, and discharge or visit paperwork. Then request an itemized bill from the provider if you do not already have one. An itemized bill shows each service, date, quantity, and code, which makes it much easier to spot mistakes and compare against what your insurance processed.
• Why should I ask for an itemized bill?
  A summary bill often shows only a total for the visit or stay. An itemized bill breaks that total into specific services, supplies, and dates. This helps you see whether all of the listed services actually happened and whether there are duplicate charges or incorrect quantities. It also gives you key details like service codes and dates that you can match against your EOB or MSN when you call the billing office or your health plan with questions.
• How do I compare my bill with my EOB or Medicare Summary Notice?
  Start by matching the basics. Check that the patient name, dates of service, provider name, place of service, and billed codes are the same or clearly connected. Then compare the billed amount on the itemized bill to the amount shown on the EOB or MSN. On the insurance document, look at what the plan allowed, what it paid, and what it lists as your responsibility. Differences in these fields often explain why a bill looks higher or lower than expected. If something does not line up, call the provider and your plan with both documents in front of you.
• What kinds of errors can I often catch by reviewing my bill?
  It is common to find issues such as services that you did not receive, wrong dates of service, duplicate charges for the same test or item, or incorrect quantities of a drug or therapy session. You might also see an out of network charge when you were at an in network facility for services that should be protected by federal surprise billing rules. If you are uninsured or chose not to use insurance and your final bill is much higher than a Good Faith Estimate you were given, that can also be an issue you can dispute.
• What are surprise billing protections and when do they apply?
  The No Surprises Act is a federal law that protects people with most group or individual health plans from many out of network surprise bills. In general, these protections apply to emergency care, to many non emergency services from out of network clinicians at in network hospitals or ambulatory surgical centers, and to air ambulance services. In those situations, you should not be billed extra amounts by out of network clinicians beyond your in network cost sharing. If you receive a bill that does not seem to follow these rules, you can ask your plan and the provider to review it and you can submit a complaint through federal medical bill rights resources.
• What is a Good Faith Estimate and when can I use it to dispute a bill?
  If you are uninsured or you choose not to use insurance for a scheduled service, you can request a Good Faith Estimate before the care. This is a written estimate of the expected charges. If your final bill is at least four hundred dollars higher than the estimate, you may be able to use the federal patient provider dispute process to challenge the bill. The timeline and steps are explained in federal materials, and it is important to keep copies of the estimate and your final bill.
• Are ground ambulance bills protected by the No Surprises Act?
  In most cases, no. Federal surprise billing protections do not generally apply to ground ambulance services, although some states have their own laws or rules that limit these charges. If you receive a high ground ambulance bill, check your state insurance or consumer protection resources and call your health plan to see whether any state level protections apply.
• What can I do if I think a provider or health plan is not following billing rules?
  You can submit a complaint to federal agencies using the Centers for Medicare & Medicaid Services medical bill rights pages. At the same time, call your health plan and ask for a claim review, and call the provider billing office to ask them to put the bill on hold while they investigate. Ask for a corrected bill if they find an error. If you have Medicare or a Medicare Advantage plan and they deny coverage or apply costs you believe are wrong, you can file an appeal by following the instructions on your Medicare Summary Notice or in your plan materials.
• What steps should I take before paying a bill I am unsure about?
  Before you pay, compare the bill against your EOB or MSN and any Good Faith Estimate. Call your health plan to confirm how the claim was processed and what your responsibility should be. Call the provider billing office, ask for an itemized bill if needed, and ask them to hold the account while they review possible errors. Keep notes of the dates, names, and reference numbers from each call and save copies of all letters and statements. If you still disagree after that, ask about appealing through your plan or Medicare.
• What if I simply cannot pay the bill?
  If the bill is from a nonprofit hospital, federal tax rules require that it have a written Financial Assistance Policy and that the hospital make reasonable efforts to see if you qualify before using harsh collection actions. You can ask the hospital for a copy of its financial assistance policy and an application. Many people qualify for reduced or even forgiven charges based on income and family size. Other types of providers may also offer payment plans or discounts, so it is always worth asking before assuming there are no options.
• How can an Understood Care advocate help me with confusing medical bills?
  On a video call, you can share your bill and related documents with an Understood Care advocate. Together, you review each line in plain language and decide whether the charge looks correct and truly needs to be paid. Advocates are used to seeing automated or premature statements that do not match what insurance has decided yet, and they focus on helping you avoid paying money you do not actually owe. If a correction, review, or appeal is needed, they can help you call the billing office and your plan, request an itemized bill, and organize the paperwork so the process is handled correctly and in a way that fits your needs.
• What should I bring to a video review of my bill with an advocate?
  It helps to have the current bill and any earlier statements, your Explanation of Benefits or Medicare Summary Notice for the same dates of service, any Good Faith Estimate you requested or received, your notes about what happened during the visit or hospital stay, and your insurance card and plan contact information. Having all of these in one place makes it easier to spot errors and speed up calls to the plan or provider.
• When should I seek help quickly about a billing issue?
  Act quickly if you see charges for services you did not receive, if you think your identity may have been confused with another patient, or if you receive collection threats while you have an open appeal or dispute. Call your plan and the provider right away and tell them an investigation is underway. If you are a Medicare beneficiary and a denial affects access to ongoing care or needed equipment, start the appeal process promptly and ask an advocate to help you gather medical records, letters of medical necessity, and other supporting documents.
• How long should I keep my medical bills and related records?
  For tax purposes, the Internal Revenue Service generally advises keeping records that support deductions, including medical expenses, for about three years. It is also wise to keep key bills, Medicare Summary Notices, EOBs, and appeal decisions at least that long in case questions arise about coverage, payment, or financial assistance later on.
• Can Understood Care help even if I am already in a billing dispute?
  Yes. An advocate can step in at any stage. They can review what has already happened, help you understand letters from the plan or provider, organize your documents, and join calls to clarify the status of the dispute. They can also help you decide whether additional steps, such as filing a formal complaint with federal agencies or applying for financial assistance, make sense in your situation.

References

• https://www.medicare.gov/what-medicare-covers/what-part-b-covers/medicare-summary-notice-msn
• https://www.cms.gov/medical-bill-rights‍
• https://www.cms.gov/medical-bill-rights/know-your-rights
• https://www.cms.gov/medical-bill-rights/using-insurance
• https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills
• https://www.cms.gov/files/document/ppdr-fact-sheet.pdf
• https://www.cms.gov/nosurprises
• https://www.irs.gov/businesses/small-businesses-self-employed/how-long-should-i-keep-records
• https://www.irs.gov/charities-non-profits/financial-assistance-policies-faps
• https://www.irs.gov/charities-non-profits/billing-and-collections-section-501r6
• https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals

This content is for education only and does not replace professional medical advice. If you have trouble breathing, chest pain, sudden confusion, or another emergency, call emergency services.