Navigating confusing 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.

FAQ

• What is an Explanation of Benefits and is it a bill?
  An Explanation of Benefits, or EOB, is a statement from your insurance plan that shows what was billed, what the plan allowed, what the plan paid, and what you may owe. It is not a request for payment. Use it to compare against any bill you receive from a provider.
• What is a Medicare Summary Notice and is it a bill?
  A Medicare Summary Notice, or MSN, is a statement Original Medicare sends about every four months. It lists services, what Medicare paid, and what may be your responsibility. It is not a bill. Review it before paying any provider statements.
• What should I do first when a medical bill arrives?
  Pause before paying. Collect the bill, your EOB or MSN, any Good Faith Estimate, and discharge papers. Ask the provider for an itemized bill that lists each service, date, quantity, and code. This makes it easier to spot errors and compare to your insurance records.
• How do I compare the bill with my EOB or Medicare Summary Notice?
  Match key details like your name, dates of service, provider, and codes. Then compare the allowed amount, what the plan paid, and what the provider says you owe. Use the itemized bill to verify that every listed service actually happened and that quantities and dates make sense.
• What common billing errors can I catch on my own?
  You may find services you did not receive, wrong dates, duplicate charges, or incorrect quantities for drugs or therapies. You might also see out of network charges for care that should have been protected under surprise billing rules or final charges that do not match a Good Faith Estimate when you did not use insurance.
• What are surprise billing protections and when do they apply?
  The No Surprises Act protects people with most group or individual plans from many out of network surprise bills. It generally applies to emergency care, certain non emergency services from out of network clinicians at in network hospitals or ambulatory surgery centers, and air ambulance services. These rules limit what you can be asked to pay.
• What is a Good Faith Estimate and how can it help me?
  If you are uninsured or not using insurance, you can request a Good Faith Estimate before scheduled care. If your final bill is at least four hundred dollars more than the estimate, you may be able to use a formal patient provider dispute process to challenge the extra amount.
• Are ground ambulance bills protected by the No Surprises Act?
  Federal surprise billing protections usually do not cover ground ambulance services, although some states have their own laws. If you receive a ground ambulance bill, check your state resources and your plan for any extra protections.
• What should I do if the bill still looks wrong after I review it?
  Call your health plan and ask for a claim review with your EOB or MSN and itemized bill in front of you. Call the provider billing office, ask them to place the account on hold, and request a corrected bill if they find errors. If Medicare or your plan denies coverage or applies costs you believe are wrong, follow the appeal instructions on your MSN or in your plan materials.
• What records should I keep and for how long?
  Keep copies of bills, EOBs, MSNs, Good Faith Estimates, letters, and notes from calls. These help with disputes, appeals, and tax questions. The IRS generally recommends keeping records that support deductions for about three years.
• What if I cannot afford to pay the bill?
  If the bill is from a nonprofit hospital, federal tax rules require the hospital to have a written Financial Assistance Policy and to try to find out if you qualify before using harsh collection methods. Ask for a copy of the policy and an application. Hospitals must limit charges for people who qualify for assistance.
• How can an Understood Care advocate help with my bills?
  On a video call, an advocate can look at your bill with you line by line and compare it to your EOB or MSN. Together you decide whether the charge is accurate and truly owed. If corrections or appeals are needed, the advocate helps you request an itemized bill, contact the billing office and your plan, and organize the paperwork so the process is clear and manageable.
• What should I bring to a video review of my medical bills?
  Have the bill and any prior statements, your EOB or Medicare Summary Notice, any Good Faith Estimate, notes about what happened during your visit or stay, and your insurance card and plan contact information. This lets your advocate see the full picture.
• When should I seek urgent help about a billing problem?
  Seek help quickly if you see charges for services you did not receive, signs of identity mix ups, or collection threats while an appeal or dispute is still open. If you are on Medicare and a denial affects ongoing care or needed equipment, start the appeal process right away and ask an advocate to help you gather supporting documents.

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.