Most individuals avoid reading their medical bills—they become anxious over them. After all, receiving a lengthy statement packed with baffling codes, unclear charges, and vague payment instructions is not only exasperating—it’s daunting. I’ve interacted with numerous people who feel overwhelmed by these documents, unsure of what they owe, the reasons behind it, or even if the charges are accurate.

This bewilderment isn’t merely typical—it’s embedded in the system. As a patient advocate and the founder of Advonav, a health care navigation service located in Dayton, Ohio, I aid patients in taking charge of their care by starting with the fundamentals: Grasping their own medical bills.

Here’s what every patient should be aware of.

1. Your medical bill differs from your EOB.

One of the most common misconceptions I observe is the mix-up between a provider’s bill and an Explanation of Benefits (EOB) from an insurance provider.

The EOB is not a bill. It’s a summary from your insurer displaying:

– The services you received
– The amount charged by your provider
– What was covered by your insurance
– What might be your responsibility

Too frequently, patients confuse the EOB as a payment demand, leading to unnecessary anxiety—or worse, double payment if they receive a bill later. Recognizing that the EOB is for informational purposes only, not actionable, is the first step towards clarity.

2. Understand what each line item signifies.

A medical bill generally includes:

– Date of service
– Service codes (CPT codes)
– Brief descriptions
– Charge amount
– Insurance payments or adjustments
– Remaining balance

However, these line items often lack straightforward language. Patients commonly inquire, “What is this charge for?” or “Why does it state I owe this if my insurance covered it?”

In many instances, the issue isn’t with what was charged—it’s with how the billing was processed. Claims submitted with incorrect codes, absent modifiers, or without necessary documentation are more likely to be denied or underpaid—errors that providers often pass on to patients.

3. Your insurance might not have been billed accurately.

Another concealed issue behind perplexing or excessive charges is improper insurance billing. Patients with multiple coverages (e.g., Medicare plus a supplement, or dual commercial plans) may discover their bill was sent to the incorrect payer or in the wrong order. This alone can prompt a denial and transfer the entire balance to the patient—until it’s rectified.

Before settling any significant medical bill, it’s prudent to verify:

– That the correct insurance was billed
– That the billing order was adhered to (primary versus secondary insurance)
– That authorization or precertification was secured—because if not, and that responsibility fell on the provider, you might not be liable for the charge.

4. The “facility fee” issue.

Hospital-owned clinics can legitimately charge a facility fee in addition to the provider’s professional fee. Most patients are unaware of this until they receive two distinct charges for one visit: one for the physician, and another for the facility.

These fees are prevalent—but they’re also preventable in many situations. Patients may be able to lessen their out-of-pocket expenses simply by opting for a private practice provider or inquiring upfront if a facility fee will apply.

5. Don’t presume the bill is definitive.

You aren’t required to unreservedly accept a medical bill as conclusive. In fact, many are up for negotiation—especially when:

– You lack insurance
– You’ve been billed out-of-network
– You’re experiencing financial difficulties
– You’ve recognized a billing or coding mistake

Patients have the right to request a detailed bill, contest charges, or seek discounts—and many providers will cooperate with you to modify the balance or propose a payment plan.

6. When unsure, seek assistance.

Most patients are not versed in coding, billing systems, or insurance policies. Yet, we anticipate them to navigate the financial aspects of health care independently.

That’s where patient advocates become essential:

– They comprehend medical bills line-by-line
– They ensure claims are submitted accurately
– They dispute denials and appeal insurance outcomes
– They lower out-of-pocket expenses through negotiation and education

We exist because the system is too intricate for most individuals to handle without help. And patients deserve more than confusion—they deserve clarity.

Deciphering a medical bill shouldn’t necessitate a background in health care administration. But until billing becomes more transparent and uniform, patients must stay alert—and empowered.

Comprehending what your bill represents (and what it doesn’t), comparing it with your EOB, confirming it was billed accurately, and seeking help when necessary can significantly affect what you pay—and how you perceive the care you receive.

Cheryl Spang is a patient advocate.