The 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. Work through it one bill at a time.

Before you start

Gather these four things:

• The itemized bill, with dates of service, descriptions and codes. If you only have a total, ask for an itemized version. It is a routine request.
• The EOB for the same claim and date of service. If it hasn't arrived, wait for it.
• Your plan's Summary of Benefits and Coverage.
• Every receipt or payment confirmation for that provider.

1. Match the bill to the claim

• Same family member on both.
• Dates of service line up.
• At least one thing beyond the amount agrees: the provider, the date or the procedure code.
• Write the claim number on the bill.

2. Check the arithmetic

• On the bill: charges minus payments minus adjustments equals the balance.
• On each EOB line: billed equals allowed plus the network discount plus anything not covered.
• On each EOB line: allowed equals what the plan paid plus your share.
• Your share equals deductible plus copay plus coinsurance.
• The lines add up to the totals printed on the EOB.

3. Compare the bill with the EOB

• The bill doesn't ask for more than the EOB says you owe.
• If it does, check whether the difference equals the network discount.
• Every payment you made appears on the bill.
• The total you paid isn't more than the EOB says you owed. A zero balance doesn't settle this.

4. Check the plan rules

• You found the right row in your plan for the service, the network status and the tier.
• The copay matches, including its unit: per visit, per day or per stay.
• The coinsurance rate matches. Divide the coinsurance by the allowed amount to check.
• No deductible was applied where your plan says the deductible does not apply.
• A clearly preventive service wasn't charged, if your plan covers preventive care at no charge.
• You weren't charged both a copay and coinsurance unless your plan states both.
• The network status makes sense for what your plan covers.

5. Check the running totals

• Your deductible status on the date of service is confirmed.
• Your out-of-pocket status on the date of service is confirmed.
• Your own total across all EOBs isn't higher than what the insurer shows.
• For families, the embedded or aggregate rule was applied correctly.
• Nothing went to the deductible after it was already met.
• Nothing was charged after you reached your out-of-pocket maximum.

6. Check dates and duplicates

• The date of service falls inside your coverage.
• No line or claim is repeated.
• No second bill exists for the same claim.
• You are working from the newest EOB, not an older version.
• The claim isn't still pending.

7. Write it down

• For each problem: the claim number, the date of service, the check that failed, the document that proves it, and the amount.
• Anything you couldn't verify, noted as unchecked.
• A date to follow up.

The first bill you check this way will take a while. It gets much faster once you know your plan. If you would rather not do it by hand, Insured Guard runs checks like these automatically on every bill and EOB you connect or upload.

General information, not legal, medical or financial advice. Every plan is different, so check the details against your own plan documents.