A typical medical bill is frightening if you do not understand how to read it.  Medical bills look different, but all include the same basic information.

 

Basic information includes the services you received, the dates you received the services, the cost of each service and your total amount owed after any applicable insurance discounts.

 

Generally, you will receive a separate bill for each type of specialty care.  This is common for more intense treatment such as cancer treatment.  You will receive a bill from each provider involved in your care.  In summary, here are the common parts to a medical bill:

 

-Your Account Number

-Services you received

-Date you received the services

-Charges for each service

-Your insurance discount

-Payment Due Date

-Amount Due

-Prior Payment date (note that payments do take time to process and may not reflect immediately on your more recent bill)

 

1.) For starters, there are the raw medical treatment “charges.”  These are the largest numbers on the medical bill.  Most patients take one look at this number and think that is the amount they owe and start to panic.  Do not panic.  This is the medical treatment cost absent any insurance discounts or financial hardship considerations.

 

2.) Next, there are likely a long list of codes that provide very little context into what treatment they represent.

 

3.) The next key item on the medical bill is the “insurance discount” or “contract allowance.”  This is what your insurance company pays.  This is often termed a “discount.”

 

4.) You may notice that your bill has only a few lines of code for what was a complicated medical treatment.  Your bill may be “un-itemized” in order to bundle similar procedures into one code or billing line.  Always request an itemized bill so that every charge is broken down.

 

Finally, the bill will give a time period for when the bill is due. This usually includes the number of days delinquent, last payment date and any new charges.  For a timeline, a bill that is less than 60 days outstanding is generally OK.  A bill that is 60-90 days outstanding is approaching trouble. A bill that is 90-120 days outstanding is likely heading to collections. And a bill that is 120 or more days outstanding is almost always sent to collections absent a hold to keep the debt with the provider.  It is important to know when you negotiate with your biller; you can extend the due date well beyond 120 days if you make the right arrangements.

Distinguish: Medical Bill versus Explanation of Benefits

 

A medical bill or “hospital bill” is different from an explanation of benefits or “EOB”.  It is important to distinguish between the two to determine what is owed and what is not.  A medical bill is a bill from your healthcare provider.  An explanation of benefits is a statement from your insurance company stating what insurance will or will not cover in regard to your treatment.  An explanation of benefits does not request payment, but the document is still useful for cross-checking with your medical bill. The magic words on your explanation of benefits are “this is not a bill.”

 

I helped create the miVoyce community and training materials with the mission to educate and empower individuals on complex healthcare topics in order to save on costs.  Join the community to learn more and start saving today!

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