Medical bill checklist: what to check before you pay

Before you pay, check that the bill is yours, that every date matches a visit and that insurance has finished with it. Then check that the lines add up to the total, that nothing is listed twice and, if you have insurance, that what you owe matches your insurer's Explanation of Benefits (EOB). Anything that does not match is worth asking the billing office about. Keep the bill, your EOB if you have one, and a calculator nearby. Outside the US, or new to it? Our guide for visitors, international students and expats adds what to check about travel and student insurance.

The checklist

1. Is it you? Check the patient name, date of birth and insurance member ID. If any of them is not yours, stop here and call the billing office.
2. Do you recognize every visit? Look at each date of service. A date that does not match a visit you remember is the first thing to ask about.
3. Has insurance processed it? If the bill says the claim is pending, or you have not received an EOB yet, the amount due may change. Ask before paying. Asked to pay before a scheduled procedure? See asked to pay before surgery.
4. Is it itemized? If you only see a total, ask for an itemized statement listing each service with its code and charge. Our free itemized bill letter can write the request for you.
5. Does each line add up? For every row, quantity multiplied by unit price should equal the line total.
6. Do the lines add up to the total? The line totals should add up to the total charges on the statement.
7. Does the totals block reconcile? Total charges, minus insurance payments, minus adjustments, should equal what the bill says you owe. If not, part of the bill may still be with your insurer, or a payment may be missing. How to read a medical bill shows the four totals on an example bill.
8. Is anything listed twice? The same code, description and amount on the same date is worth a question. Sometimes it is correct (two doses, two sides of the body), sometimes it is not. Our guide on duplicate charges on a medical bill shows which repeats are worth asking about.
9. Does it match your EOB? The amount your insurer says you owe (often called patient responsibility) should match the bill. If the bill asks for more, ask why. If you already paid more than the EOB says you owe, see how to ask for a refund on an overpaid medical bill. Reached your yearly limit? See met your out-of-pocket maximum but still getting bills.
10. Are the codes plausible? You do not need to know every code, but an emergency visit billed at the highest level, or a service you did not receive, is a fair question. Our guide to medical billing codes explains what the numbers mean.

How can I tell if my hospital bill is correct?

Only the hospital or your insurer can confirm that. What you can do is compare the bill with what happened and ask about anything that does not fit. Our guide to common medical bill errors shows eight kinds, the ordinary reasons a line can look that way and what to ask about each, and how common medical billing errors are sums up what surveys found. After a hospital stay, MedlinePlus (from the National Library of Medicine) suggests a few checks the list above does not cover:

• Room days. The dates should match your stay. If you went home in the morning, look at whether that day carries a full day's room rate.
• Medicines you brought. If you took your own medicines from home, check whether the bill charges for them.
• Generic or brand. If a generic medicine was prescribed, check which one was billed.
• Routine supplies. Gloves, gowns or sheets on their own lines are worth a question. MedlinePlus says the hospital's general costs should cover them.
• A test read twice. MedlinePlus says reading a test or scan should be charged once, unless you had a second opinion.
• Cancelled orders. A test, procedure or medicine that was ordered and then cancelled is worth asking about if it is on the bill.

CMS adds one more check: ask your provider for a copy of your medical records and compare them with the bill. If the bill lists something your records do not show, CMS says to talk to the provider's billing department. Some providers charge a fee for copies, so ask the billing department about it first.

How to ask about what you found

Call the billing number on the statement and ask about specific lines, not the bill as a whole. Phrase each point as a question: "Can you explain line 4? I see the same code twice on the same date." Write down who you spoke to, the date, and what they said. If a line is changed, ask for a corrected statement before you pay.

If you have insurance and the bill does not match your EOB, your insurer can often help too. The phone number is on your insurance card.

If a hospital bill is more than you can pay, the hospital may have a financial assistance (charity care) policy. Our free financial assistance request letter asks for the policy and the application form.

Faster with MedBillCheckup

MedBillCheckup runs these checks for you. Take a photo of the bill or choose the PDF: your own browser reads it, so the file stays on your device (can a bill be checked without uploading it?). It lays out every charge it read and checks the arithmetic, the dates and the repeats. The free check shows how many things are worth asking about, and the largest amount you may get back or may not owe. The full list, which is paid, shows which charges, why, and the questions worth asking your provider, each with the exact reason. It never tells you a charge is wrong; only your provider or insurer can confirm that.