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A medical bill you cannot make sense of
The documents you will see
- The itemized bill from the provider (request one if you only got a summary)
- The EOB from your insurer for the same date of service
- Your plan's deductible and out-of-pocket status
- Any prior authorization or referral paperwork
The order to work in
- Request the itemized bill; summaries hide the errors.
- Match each billed line to the EOB: dates, codes, amounts billed, allowed, paid, and assigned to you.
- Flag the mismatches: duplicate lines, services you did not receive, amounts that exceed the EOB's patient responsibility.
- Ask the provider's billing office, in writing, to explain or correct each flagged line.
- If insurance processed it wrong, open the insurer's appeal process and note its deadline from the EOB or denial letter.
Deadlines, and where they live
Insurer appeal windows are set by your plan and printed on the EOB or denial notice; many plans allow 180 days from the notice, but your document controls. Balance-billing protections under the federal No Surprises Act cover many emergency and out-of-network situations; the official overview is at healthcare.gov. Provider billing offices also work to their own timelines, so written questions early beat phone calls late.
Primary source: Consumer Financial Protection Bureau, medical billing guidance.
The kit that does this work with you
Medical Bill and Insurance Denial Review Kit: Three documents, three stories: the hospital's bill, the insurer's EOB, and the denial letter. Guide, editable workbook, and letter templates, $49.
New to PocketBack? Start with The Paperwork Audit, our free checklist covering six everyday documents, this topic included where it fits.