Medical Bill & EOB Review Worksheet
Gather the itemised bill and the matching Explanation of Benefits, then walk them side by side: duplicate charges, services or supplies never received, dates outside the actual visit, in-network versus out-of-network status for the facility and each treating provider, and whether the balance being billed exceeds the patient responsibility the EOB states. It ends with the questions to ask the provider's billing office and the plan, written out one per disputed line. It organises a review — it does not reprice anything.
Fill & print the form
Runs entirely in your browser — nothing is uploaded; your answers are saved only on this device.
Frequently asked
Does it tell me whether a charge is correct or overpriced?
No. It does not reprice a claim, decide whether a charge is right, or check coding — that is not what this is. It organises the documents, surfaces the things worth asking about, and gives you the questions to ask.
Is this medical, coding or legal advice?
No. It is a documentation and organisation worksheet. Nothing in it is medical advice, coding advice or legal advice, and the answers come from your provider and your plan, not from the form.