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