How to read a medical bill

Most medical bills contain the same handful of numbers, arranged differently by each provider. Once you know which ones should agree with each other, a confusing statement becomes readable.

Start with the four totals

Nearly every US statement has some version of these:

Line	What it means
Total charges (or total billed)	The provider's list price for everything on the statement, before insurance.
Insurance payments	What your insurer actually paid the provider.
Adjustments (or contractual adjustment, discount, write-off)	Amount removed under the agreement between your insurer and the provider. You are not asked to pay this.
Patient responsibility (or amount due, balance)	What the statement says is yours to pay.

In the simplest case these relate like this:

Total charges − insurance payments − adjustments = patient responsibility

If they do not, that is not proof of an error. Part of the bill may still be with the insurer, you may have made a payment already, or the statement may combine two visits. But it is a reasonable thing to ask about, and the billing department can walk you through it.

Then read the line items

An itemized statement lists each service on its own row. A row usually has:

• Date of service. The day the service happened, which can differ from the statement date.
• Description. Sometimes plain English, sometimes abbreviated hospital shorthand.
• Billing code. Five digits is usually a CPT code for a procedure or service. A letter plus four digits is usually HCPCS, used for supplies and drugs. Four digits starting with zero is usually a revenue code, which groups charges by hospital department.
• Quantity and unit price. Multiply them. The result should equal the line total.
• Charge. What the provider billed for that row.

If your statement has no line items at all, you can ask for an itemized statement. Providers generally supply one on request, and it is the single most useful document for understanding a bill.

Two charges for one visit is normal

Seeing a hospital charge and a separate doctor charge for the same visit surprises many people, but it is standard. The facility fee covers the building, equipment and staff. The professional fee covers the clinician's own work. They arrive as separate lines, sometimes as separate bills from different entities.

That does not mean every pair of similar charges is legitimate. It means a similar-looking pair is a question, not a conclusion.

Numbers worth checking yourself

You can do these with a calculator in a few minutes:

1. Each line: does quantity × unit price equal the line total?
2. All lines: do the line totals add up to the subtotal or total charges?
3. The totals block: do insurance payment, adjustments and patient responsibility account for the total billed?
4. The dates: is any date of service after the statement date, or from a visit you do not recognize?
5. Repeats: does any description, code and amount appear twice on the same date?

Anything that does not reconcile is a question for the billing department, phrased as a question.

What to do next

Write down what you found, then call the number on the statement. Ask them to explain the specific lines rather than the bill as a whole. Ask for the itemized statement if you do not have one. If you have insurance, compare the bill against your Explanation of Benefits before paying.

If you would rather not do the arithmetic by hand, open the bill in MedBillCheckup (it is read on your device and never uploaded) and we will do these checks for you and write the questions out.