How to read an EOB and find the charge you shouldn't pay

The Explanation of Benefits your insurer sends is not a bill, and the bill the provider sends is often not itemised. Most people pay whatever arrives. Putting the two side by side is where the questionable lines appear.

The comparison, in order

• Ask for the itemised bill. A summary balance cannot be checked against anything. You are entitled to ask.
• Match it line by line to the EOB. Charges that appear on the bill but not the EOB are the first thing to question.
• Look for duplicates and for services on dates you were not there.
• Check network status. An out-of-network charge inside an in-network facility is worth questioning specifically.
• Separate genuine patient responsibility — deductible, copay, coinsurance — from a balance bill that may not be yours to pay.

If something is wrong

Appeal in writing, to the deadline printed on your denial letter, and keep proof of sending. Your plan has a written appeal procedure, and most states have an external review process through the insurance regulator once internal appeals are exhausted.

The Billing, Appeals & Disputes pack has the review worksheet and generates an appeal letter from your details. It organises a review — it does not reprice a claim, decide whether a charge is correct, or give medical, coding or legal advice.