Quiz: Can You Read a Medical Bill? 8 Questions That Trip Up Careful Patients

Quiz · 8 questions · about 3 minutesYou open the envelope, find the total and reach for a card. Most billing mistakes are made in that moment. See how many of these eight situations you would handle correctly.

Each question below is a situation patients run into every week. Tap the answer you think is right. The correct answer and a short explanation appear immediately, and your score is counted at the bottom of the page.

How it works: one answer per question, and it locks once you choose. Nothing you tap is saved or sent anywhere. To start again, reload the page.

Question 1 of 8

A letter from your insurer is titled “Explanation of Benefits.” It lists a doctor visit and says “Patient responsibility: $240.” What should you do?

Pay the insurer $240 by the date shown. Keep it, and compare it with the provider’s bill when that arrives. Nothing. It is a receipt showing the visit was paid in full. Call the doctor, because the claim was denied.

Correct. Not quite. An Explanation of Benefits is not a bill. It shows how the plan processed a claim and what it says you may owe. Payment goes to the provider, and only after the provider’s bill matches the EOB. More: Are You Overpaying Your Doctor? The Secret Lies in Your EOB.

Question 2 of 8

Your plan has a $2,000 deductible and you have now met it. What happens with your next covered, in-network visit?

It is free. The plan pays everything from here on. You pay full price until the calendar year ends. You usually pay a copay or coinsurance until you reach the out-of-pocket maximum. Your monthly premium goes down.

Correct. Not quite. Meeting the deductible starts cost sharing. It does not end it. On most plans you keep paying a share, such as 20 percent, until your spending reaches the out-of-pocket maximum. After that the plan pays 100 percent of covered in-network care for the rest of the plan year. More: Your Health Plan Has a Number That Can Cap Your Bills.

Question 3 of 8

An in-network bill shows: amount billed $1,200, plan’s allowed amount $700, plan paid $560. Your deductible is already met. What do you most likely owe?

$640, the amount billed minus what the plan paid. $500, the difference between billed and allowed. $0, because the plan paid. $140, the allowed amount minus what the plan paid.

Correct. Not quite. An in-network provider has agreed to accept the plan’s allowed amount. The $500 between the billed charge and the allowed amount is written off and is not yours to pay. Your share is what remains of the allowed amount: $700 minus $560, or $140. More: “Insurance Paid” Doesn’t Mean “You Owe $0.” Here’s the Math.

Question 4 of 8

You go to the emergency room at an in-network hospital. The physician who treats you turns out to be out of network. Under the federal No Surprises Act, what can that physician generally bill you?

Only your normal in-network cost sharing for the emergency care. The full difference between the charge and what your plan paid. Nothing at all, not even a copay. Whatever you agreed to on the intake forms.

Correct. Not quite. For most emergency care, out-of-network providers cannot bill you for the balance above what the plan pays. You owe the same copay, coinsurance or deductible you would owe in network. More: The Doctor You See May Not Be the Doctor Your Insurance Pays For.

Question 5 of 8

Which of these is generally not covered by the federal surprise billing protections?

An air ambulance flight. Emergency room care at an out-of-network hospital. A ground ambulance ride. An out-of-network anesthesiologist at an in-network hospital.

Correct. Not quite. Ground ambulances were left out of the No Surprises Act. An out-of-network ambulance company may be able to bill you for the amount your plan did not pay, unless a state law says otherwise. More: Your ER Visit Was Covered. So Why Did the Ambulance Send Its Own Bill?

Question 6 of 8

Which of these counts toward your plan’s out-of-pocket maximum?

Your monthly premiums. Deductibles, copays and coinsurance for covered, in-network care. Balance bills from out-of-network providers. Services your plan does not cover.

Correct. Not quite. The out-of-pocket maximum counts what you pay in cost sharing for covered, in-network services. Premiums, non-covered services and out-of-network balance bills generally sit outside it, which is why the “maximum” is not always the most a household can spend. More: Your Health Insurance Has a Spending Limit. But What Does It Actually Protect You From?

Question 7 of 8

A debt collector calls about a $900 medical bill you do not recognize. What is the best first step?

Pay a small amount to show good faith. Confirm your Social Security number so they can find the account. Ignore the calls. Old medical bills expire on their own. Ask for the written validation notice, and dispute in writing within 30 days if anything is wrong.

Correct. Not quite. A collector must send written details of the debt. If you dispute in writing within about 30 days of receiving that notice, collection has to pause until the debt is verified. A partial payment can, in some states, restart the time limit for a lawsuit. More: A Debt Collector Called About a Medical Bill. You Have 30 Days to Do This First.

Question 8 of 8

Your plan covers the annual physical at $0. During the visit you ask the doctor to look at a knee that has been hurting for a month. What can happen to the bill?

Nothing. Everything said in a preventive visit is free. The office may bill a separate problem visit, with your normal copay or deductible. The whole physical loses its $0 status. The office is not allowed to charge anything extra on that day.

Correct. Not quite. The preventive exam stays at $0. Evaluating a new symptom is a different service, and the office can bill it as a second visit on the same day. Asking “will this change how today is billed?” at the start keeps the choice in your hands. More: Your “Free” Screening Came With a Bill.

Your score

/ 8

You have answered of 8 questions.

What your score suggests

7 to 8	You read bills the way a billing specialist does. The habit to keep is waiting for the EOB before paying anything.
4 to 6	You know the main terms. The questions you missed point to the documents worth a second look the next time a bill arrives.
0 to 3	You are in large company. Nobody is taught this, and the paperwork is not designed to be easy. The links under each answer are the place to start.

Three habits that cover most of these situations

Wait for the EOB. A provider’s first statement can arrive before the insurer has finished processing the claim. The EOB tells you what the plan decided and what it says you owe.

Match three things. The date of service, the provider’s name and the patient responsibility amount should be the same on the bill and on the EOB. When they differ, call the provider’s billing office before paying.

Ask before, not after. Before a test, a procedure or a visit away from home, ask who will bill for it and whether they are in your network. Our checklist 9 Questions to Ask Before You Pay a Medical Bill covers the rest.

Sources: Centers for Medicare & Medicaid Services, consumer guides to medical bills, Explanation of Benefits and the No Surprises Act; HealthCare.gov glossary and preventive care guidance; Consumer Financial Protection Bureau, debt collection guidance. This quiz is general information, not legal or medical advice. Your own plan’s terms decide what you owe.

What your score suggests

Three habits that cover most of these situations

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