Medical bills, decoded
Practical guides, real case files and plain-language explanations of the plan terms that decide what you owe.
How to check a medical bill against your EOB before you pay
An Explanation of Benefits (EOB) is not a bill. It is your insurer's record of how a claim was processed: what the provider charged, what the plan allowed, what the plan paid, and what it says you owe.
Read articleBefore your appointment: how to confirm your coverage and avoid a surprise bill
Many surprise bills are decided before you walk in the door. A few minutes of preparation can tell you roughly what a visit will cost and whether you are likely to receive a bill you did not expect.
Read articleGot an unexpected medical bill? What to do before you pay it
An unexpected bill is not necessarily a correct one. Before you pay, a few steps protect you and often reduce what you owe.
Read articleYour bill, your EOB and your plan: what each one can prove
Most people receive three kinds of documents about the same medical visit and treat them as if they say the same thing.
Read articleHow one medical charge splits into five numbers
Every line on an Explanation of Benefits does the same small piece of arithmetic. Once you can follow it, most of the page starts to make sense, and the numbers that don't belong stand out.
Read articleHow to match a medical bill to the right insurance claim
Every check on a medical bill starts with one assumption: that you are comparing the bill with the right claim.
Read articleHow to ask for a medical bill correction or refund, with a letter template
Finding a billing error is only half the job. Getting it corrected is a separate skill, and most of it comes down to making your request easy to approve.
Read articleThe one-page medical bill audit checklist
When a bill looks wrong, the hardest part is knowing where to start. This checklist puts the checks in a sensible order, cheapest first.
Read articleMedical billing glossary: the terms that matter, in plain English
Medical bills and insurance statements use a vocabulary of their own. These are the terms that matter most when you are checking what you owe, in plain English.
Read articleSame number, different names: an EOB field translator
One reason EOBs are hard to read is that every insurer labels the same numbers differently. The allowed amount on one statement is the eligible amount on another and the approved amount on a third.
Read articleWhy the same blood test can have three prices in your plan
Most people read a row in their benefits summary as one price per service. Often it isn't. A single row can contain several prices, and which one applies depends on where the care happened.
Read articleKnow your plan before you check a bill: build a one-page plan profile
People usually describe a health plan by two numbers: the premium and the deductible. In practice a plan has many more settings, and they interact.
Read articleWhy medical billing errors go unnoticed
Almost every other bill you receive is easy to check. A restaurant receipt lists what you ordered at the prices on the menu.
Read articleThe three checks every Explanation of Benefits must pass
If you learn nothing else about reading an Explanation of Benefits, learn these three lines. They take a minute and they need no knowledge of your plan.
Read articleWhen the numbers on your EOB don't add up
The four numbers on this line add up to $160. The line says you owe $200.
Read articleCorrect math, wrong rule: when your plan is applied incorrectly
This Explanation of Benefits was arithmetically perfect. Every column added up. It was still wrong.
Read articleCharges that were never yours to pay
The statement asked for $530. The Explanation of Benefits said the patient owed $118.
Read articleWhat you paid versus what you owed: the simplest refund check
This is one of the most reliably profitable checks in medical billing, and one of the simplest.
Read articleWhen your insurer's deductible tracker falls behind
Here is a check almost nobody runs, and it is the one with the longest tail.
Read articleWrong dates on medical bills, and why they cost you
The quietest source of medical billing error is dates, because a wrong date almost never looks wrong.
Read articleCase file: a copay on a visit the plan covers in full
A $40 copay collected at check in for an annual wellness visit. Routine, plausible, and paid without a second thought.
Read articleCase file: a deductible charged where the plan waives it
An Explanation of Benefits for a diagnostic laboratory panel showed $180 applied to the deductible, with the full amount left with the patient.
Read articleCase file: charged the wrong provider tier rate
The patient share on this outpatient procedure felt high, but everything on the page added up. That is what makes tier errors hard.
Read articleCase file: a penalty for someone else's missing prior authorization
The remark text on this Explanation of Benefits said plainly that a required prior authorization had not been obtained.
Read articleCase file: the same claim decided twice
A second Explanation of Benefits arrived for a claim that had already been settled and paid, under the same claim number with a revision suffix.
Read articleCase file: an out-of-network charge on a plan with no out-of-network benefit
This plan priced every out of network column as not covered. Then a routine outpatient claim was processed as out of network, leaving $780 with the patient and counting none of it toward the caps.
Read articleWhat "no charge" means in your plan
Two words in a benefit schedule that people read straight past: no charge.
Read article"No charge after deductible" does not mean free
Five words that mean the opposite of what a quick read suggests: no charge after deductible.
Read article"Deductible does not apply": a phrase that can save you money
If you only learn one phrase from your plan document, learn this one: deductible does not apply.
Read article"Coinsurance without deductible" and why it trips people up
This is the plan phrase most likely to make you wrong, so it is worth knowing before you pick up the phone.
Read article"Not covered" versus "no charge"
Not covered and no charge sit in the same column of the same table and mean opposite things. Confusing them in either direction is expensive.
Read articleCharged a copay and coinsurance for the same service?
You were charged a copay and coinsurance for the same service. Is that wrong?
Read articleEmbedded or aggregate deductible: which one does your family plan use?
One sentence in a Summary of Benefits and Coverage decides whether the figures above are an overcharge or completely correct.
Read articleYour provider tier isn't printed anywhere. Here's how it is decided
On a tiered plan, the tier that governs a claim is not printed anywhere before the claim is processed. It is derived, from provider data that is not always current.
Read articleThe plan year and the reset date aren't always the same
Here is a plan mechanic that catches even careful people.
Read articleNot every dollar you pay counts toward your out-of-pocket maximum
Most people believe the out-of-pocket maximum is a promise: spend this much and you are done for the year.
Read articleWant a second pair of eyes on your bills?
Send us your bills and EOBs, and we'll show you exactly where they disagree.