How to compare a medical bill with an EOB

Your insurer’s Explanation of Benefits (EOB) explains how it processed a claim; it is not a bill. Compare its patient balance with the provider’s bill for the same claim.

Compare the documents

1. Match patient, provider, service dates, and claim or account numbers.
2. Compare billed charges, allowed amount, insurer payment, adjustments, and patient balance.
3. Subtract any copay or other payment you already made from what remains due.
4. If the provider bill is higher than the EOB patient balance, ask the provider and insurer to explain the difference.

Synthetic example

In a fictional claim, the EOB lists $300 billed, $200 allowed, $150 paid by insurance, and a $50 patient balance. If the later provider bill asks for $100 and no other charge applies, ask why it exceeds $50.

Limits

Claims can be reprocessed, and a bill may contain several claims or dates. A denial or adjustment alone does not establish that the patient owes nothing.

Source: CMS medical bill guidance

Related guides

• How to read an itemized medical bill
• How to question a suspected medical billing error