What to do when your medical bill doesn't match your Explanation of Benefits

Up to 80% of medical bills contain at least one error. For bills over $10,000, the average mistake costs $1,300. And yet fewer than half of people who receive an incorrect bill ever challenge it[1]. This is mostly because they don't know they can[2].

If you've received a hospital bill and an Explanation of Benefits from your insurance company and the numbers don't match, you're not alone. You're also not necessarily wrong to be confused. This happens constantly and it doesn't always mean someone made a mistake. This does mean you need to pay attention before you pay anything.

Here's where to start:

Don't pay the bill yet. Wait until you understand what you actually owe. Paying before you verify locks in a number that may be wrong.

Read your EOB carefully. Your insurance company is showing you what they agreed to pay, what they denied, and what they're passing to you. If something was denied, there's a reason code on the document and that code matters more than the dollar amount.

Call the billing department and ask for an itemized bill. A standard bill shows totals. An itemized bill shows every charge line by line. Errors such as duplicate charges, incorrect codes, services you never received will only show up on the itemized version.

Compare the two documents side by side. What did insurance say you owe versus what the hospital is billing you? If those numbers don't match, ask the billing department to explain the difference in writing.

Don't ignore collection notices. If a bill goes to collections before you've resolved a dispute, it affects your credit. If you're actively disputing a charge, document everything and request that collections be paused in writing.

The average family loses $500 a year to billing errors they never catch[3]. Most of that money doesn't come back and it’s not because it can't but because nobody had the time or energy to chase it down after an already stressful medical event.

That's exactly what Resolve Ops is here. If you're staring at a stack of bills and don't know where to start, we step in, sort it out, and make sure you're only paying what you actually owe.

This article is for informational purposes only and does not constitute legal, medical, or financial advice.