Why Medical Bills Are So Confusing
Medical bills are complex because they involve three parties with different incentives:
- Provider: Bills for services at their standard rates
- Insurance: Negotiates discounted "allowed amounts" via contracts
- You: Pay the difference (deductible + coinsurance + copay)
The bill you receive shows charges in medical billing codes (CPT/HCPCS), not plain English. You need both your bill and your Explanation of Benefits (EOB) to understand what you owe.
5-Step Process to Understand Your Bill
Request an Itemized Bill with CPT Codes
Call billing department: "I need a detailed, itemized bill showing CPT codes, descriptions, and charges."
Why: Summary bills hide details. Itemized bills show exactly what services you're being charged for.
Get Your Explanation of Benefits (EOB)
Log into your insurance portal or call to request the EOB for this date of service.
Why: The EOB shows what insurance approved, what they paid, and what YOU owe. The bill alone doesn't tell you this.
Compare Bill to EOB Side-by-Side
For each line item, verify these numbers match:
| Field | On Your Bill | On Your EOB |
|---|---|---|
| CPT Code | 99214 | 99214 |
| Billed Amount | $250 | $250 |
| Allowed Amount | — | $150 (contract rate) |
| Insurance Paid | — | $120 |
| You Owe | — | $30 (your share) |
Key: You should only pay the "patient responsibility" from the EOB, NOT the full billed amount.
Decode the CPT Codes
Use our CPT code database or Bill Checker to understand what each code means.
99214 = Office visit, established patient, 30-39 minutes
36415 = Routine blood draw
80053 = Comprehensive metabolic panel (blood test)
Check for Common Errors
- ✓ Duplicate charges (same code listed twice)
- ✓ Services you didn't receive
- ✓ Wrong dates or wrong patient
- ✓ Balance billing (charged more than EOB says you owe)
Use our free Bill Checker to automatically detect these issues.
Still Confused? Check Your Bill Automatically
Our Medical Bill Checker analyzes CPT codes, detects errors, and explains charges in plain English. Free to use, no signup required.
Check Your Bill Now →Medical Billing Terms Explained
- CPT Code
- Current Procedural Terminology code. A 5-digit number identifying a medical service (e.g., 99214 = office visit).
- Allowed Amount
- The maximum your insurance agrees to pay for a service based on their contract with the provider. You only pay a percentage of this, not the billed amount.
- Deductible
- Amount you must pay out-of-pocket before insurance starts covering services. Resets annually.
- Coinsurance
- Your share of costs after deductible is met (e.g., 20% coinsurance means you pay 20%, insurance pays 80%).
- Balance Billing
- When a provider bills you for the difference between their charges and the insurance-allowed amount. Usually illegal for in-network providers.
- EOB (Explanation of Benefits)
- Document from insurance showing what was billed, what they approved, what they paid, and what you owe. Not a bill.
For Healthcare Providers
Patient confusion indicates documentation gaps. Complete, accurate documentation ensures proper coding, reduces billing inquiries, and speeds payment. OrbDoc automates clinical documentation for Medicare compliance.