3 Signs Your Medical Bill Might Be Too High
1. Charges Don't Match Your Explanation of Benefits (EOB)
Red Flag: Your bill shows a higher amount than the "patient responsibility" listed on your insurance EOB. This could indicate balance billing (often illegal for in-network providers).
What to check: Compare the total charges, allowed amounts, and your share line-by-line between your bill and EOB.
2. Duplicate or Unbundled Services
Red Flag: Same CPT code listed multiple times, or separate charges for services that should be bundled together (e.g., surgical prep charged separately from the surgery).
What to check: Look for repeated CPT codes or procedures that seem related being billed separately.
3. Charges for Services You Didn't Receive
Red Flag: Bill includes procedures, tests, or supplies you don't remember receiving (common in hospital stays with multiple departments).
What to check: Request an itemized bill and verify every line item against your memory and medical records.
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Check Your Bill Now →How to Verify If Your Bill Is Accurate
Step 1: Request an Itemized Bill
If you haven't already, call the billing department and request a detailed, itemized bill with CPT codes. This shows exactly what you're being charged for, not just summary totals.
Step 2: Compare to Your Explanation of Benefits (EOB)
Key numbers to compare:
- Total Charges: What the provider billed
- Allowed Amount: What insurance approved (contracted rate)
- Insurance Paid: What insurance covered
- Your Responsibility: Deductible + coinsurance + copay
Important: If your bill is higher than "Your Responsibility" on the EOB, and the provider is in-network, this is likely balance billing (illegal in most states for in-network care).
Step 3: Check for Common Billing Errors
Use our Medical Bill Checker or manually verify:
- Duplicate charges: Same CPT code listed more than once
- Unbundling: Services billed separately that should be bundled
- Upcoding: Higher-level service code than what was actually provided
- Services not received: Charges for procedures you don't remember
- Incorrect dates: Services billed for dates you weren't at the facility
Step 4: Research Typical Costs
Look up the CPT codes from your bill using our CPT code database to see typical cost ranges and descriptions. If your charges are significantly higher than typical ranges, that's a red flag.
What to Do If Your Bill Is Too High
Option 1: Dispute Billing Errors (Highest Success Rate)
When this works: When there are actual errors (duplicates, wrong codes, services not received, balance billing violations).
Success rate: 70-90% if you have documentation.
How to do it: Call billing department, explain the specific error (use CPT codes), request a corrected bill. Follow up in writing. Keep all records.
Option 2: Apply for Financial Assistance (Income-Based)
When this works: When your income is below a certain threshold (varies by hospital, often 2-4x federal poverty level).
Typical discount: 50-100% of charges depending on income.
How to do it: Ask for a "charity care application" or "financial assistance program." Requires documentation (pay stubs, tax returns).
Option 3: Negotiate Payment (Limited Success)
When this works: Uninsured patients or when requesting payment plans.
Reality check: Once insurance has processed your claim, providers are legally bound by contracted rates. They can't arbitrarily discount without violating their insurance contract.
What you CAN negotiate: Payment plans, prompt-pay discounts (if you're uninsured), or application for formal financial assistance programs.
What Doesn't Work
Don't waste time on these tactics:
- ❌ Asking for a discount on legitimate charges after insurance processing (illegal for in-network providers)
- ❌ Threatening not to pay (damages your credit and doesn't reduce legitimate charges)
- ❌ Demanding explanations without specific questions (billing staff get these calls all day)
Instead: Focus on errors (which are your legal right to dispute) or financial assistance (which is a formal program with income requirements).
For Healthcare Providers
Billing confusion creates patient friction, delayed payments, and administrative burden. OrbDoc helps providers document accurately for proper coding, reducing billing disputes at the source.