7 Medical Bill Errors You Should Check Before Paying

You open your mailbox and find a medical bill for $1,847.

Your first instinct may be simple: pay it, forget about it, and move on.

But before you reach for your credit card, take a few minutes to look at the bill.

A medical bill can contain charges that are difficult to understand, especially when you are dealing with insurance claims, multiple providers, hospital departments, procedure codes, and an Explanation of Benefits (EOB).

That does not mean every unfamiliar charge is an error. Medical billing is complicated, and legitimate healthcare bills can contain terminology that looks strange to patients.

But there are several things you can check before assuming the amount on the bill is correct.

1. Check for Duplicate Medical Charges

One of the simplest things to look for is a charge that appears more than once.

You might see the same procedure, medication, supply, or service listed twice.

If two entries have the same description and date, it is reasonable to ask the billing department whether they represent separate services or a duplicate entry.

However, do not assume that two similar charges automatically mean you were billed twice.

A hospital visit can involve multiple providers and separate services. Some charges may look similar even though they represent different parts of your care.

Look carefully for:

• The same service appearing twice.
• The same medication appearing multiple times without an explanation.
• Repeated supplies or procedures.
• Two charges with the same date and description.
• A charge that appears to have already been paid.

If you find a potential duplicate, write down the exact line items before contacting the provider.

2. Make Sure You Were Actually Charged for Services You Received

This sounds obvious, but it is one of the most useful checks you can make.

Medical bills often contain technical descriptions and billing codes that may not resemble the words your doctor used during your visit.

Go through the bill and ask:

• Did I actually receive this service?
• Was this test performed?
• Did I receive this medication or treatment?
• Was I receiving care on this date?
• Does the charge generally correspond with what happened during my visit?

You may also encounter terms such as upcoding or unbundling when researching medical billing problems.

Upcoding generally refers to billing for a higher-level or more expensive service than the service actually provided.

Unbundling generally refers to billing separately for services that may be intended to be reported together under applicable coding or billing rules.

These are technical issues and cannot be determined simply by looking at a bill. If you suspect something is wrong, ask the provider to explain the relevant charge and coding.

3. Compare Your Medical Bill With Your Explanation of Benefits (EOB)

If you have health insurance, this may be the most important comparison you make.

After an insurer processes a claim, it may send you an Explanation of Benefits, commonly called an EOB.

An EOB is not a bill.

Instead, it explains how your insurance plan processed the claim.

Depending on the plan and claim, an EOB can show information such as:

• What the provider charged.
• The amount considered an allowed charge.
• What the insurance company paid.
• Adjustments applied under the plan.
• The amount identified as your responsibility.

CMS recommends comparing your medical bill with your EOB and checking that the services and amounts make sense together.

What Should You Compare?

• Date of service.
• Provider or facility.
• Services listed.
• Amount charged.
• Insurance payment.
• Insurance adjustment.
• Patient responsibility.

If your provider’s bill appears higher than the amount your EOB identifies as your responsibility, contact the provider and ask why.

Do not assume every difference is an error. Timing differences, separate claims, or billing processes can sometimes explain why documents do not look identical.

But if you cannot reconcile the numbers, it is worth asking.

4. Check Your Name, Insurance Information, and Other Details

Before investigating complicated billing codes, check the basic information.

Make sure the bill belongs to the correct patient and that the information appears accurate.

• Patient name.
• Date of service.
• Provider or facility.
• Insurance company.
• Member or policy information.
• Account information.

An outdated insurance card, incorrect member information, or a claim sent to the wrong insurer can create confusion about how the claim was processed.

If something appears incorrect, contact the provider’s billing department and your insurer as appropriate.

Do this sooner rather than later. Keeping a questionable bill in a drawer does not make the problem disappear.

5. Look Carefully at In-Network and Out-of-Network Charges

Another common source of unexpected healthcare costs is the difference between in-network and out-of-network care.

If your insurance plan uses a provider network, check how the provider or facility was treated under your specific plan.

This can become complicated because one healthcare visit can involve several providers.

For example, you may receive care at an in-network hospital while another provider involved in the treatment submits a separate claim.

That is why you should check the actual claim and EOB instead of assuming that every provider involved in your visit was treated identically by your insurance plan.

What About Surprise Medical Bills?

The federal No Surprises Act provides protections in certain circumstances involving unexpected out-of-network bills, including certain emergency services and some services provided at participating facilities.

However, the protections have specific conditions and exceptions. Not every out-of-network bill automatically qualifies.

If you believe you received a surprise bill that may be protected, review your EOB, contact your health plan, and ask the provider why the charge was processed that way.

6. Check Whether Your Payments and Insurance Adjustments Were Applied Correctly

Sometimes the original medical charge is not the problem.

The problem may be what happened afterward.

For example, your current balance may not appear to reflect:

• A copayment you already made.
• A previous payment.
• An insurance payment.
• An insurance adjustment.
• Applicable financial assistance or discounts.

Instead of looking only at the original amount charged, look at how the provider arrived at the final balance.

If you already made a payment, compare the provider’s statement with your receipt, bank record, or payment confirmation.

If insurance has processed the claim, compare the provider’s balance with the EOB.

7. Ask for an Itemized Medical Bill

If you receive a large bill that shows only a total balance, ask the provider for an itemized statement.

An itemized bill can make it much easier to understand where the balance came from.

Depending on the provider, it may show individual services, supplies, medications, procedures, dates, and billing codes.

Once you receive it, compare the information with your EOB and your own records.

Look for:

• Duplicate charges.
• Services you do not recognize.
• Incorrect dates.
• Unexpected quantities.
• Payments that were not credited.
• Amounts that do not appear consistent with your EOB.

If a line item is confusing, ask the billing department to explain what it represents.

What to Say When You Call the Billing Department

You do not need to become a medical billing expert before making the call.

The key is to ask a specific question about a specific charge.

What If You Cannot Afford the Medical Bill?

Finding a possible billing error and being unable to afford a legitimate bill are two different problems.

But they can happen at the same time.

If the bill appears correct but you cannot afford the balance, contact the provider rather than simply ignoring the account.

Ask whether the hospital or provider offers:

• Financial assistance.
• Charity care.
• Payment plans.
• Discount programs.
• Other assistance for qualifying patients.

Nonprofit hospitals generally have financial assistance policies under federal requirements, but eligibility and the amount of assistance depend on the hospital’s policy and the patient’s circumstances.

Do not assume that you automatically qualify for a completely free bill.

Instead, ask the hospital for its Financial Assistance Policy and application process.

Do Not Ignore a Bill Just Because You Think It Is Wrong

Questioning a medical bill is not the same as ignoring it.

If you believe something is incorrect, contact the provider or insurer and start the process of getting the issue reviewed.

Keep copies of your documents and records of your conversations.

If the issue involves an insurance claim denial, check your plan documents for the applicable appeal process and deadlines.

The Bottom Line

A medical bill can look intimidating, especially when the balance is hundreds or thousands of dollars.

But you do not have to become an expert in the U.S. healthcare system to perform a basic review.

Check what you were charged for. Confirm that you received the services. Compare the bill with your EOB. Verify payments and adjustments. And ask questions about anything you cannot reconcile.

A strange-looking charge is not automatically proof of a billing error.

But if you cannot explain where a charge came from or why you owe the amount shown, it is reasonable to ask questions before paying.