How to read a medical bill and an explanation of benefits
The bill shows what the provider charged and what it says you owe; the explanation of benefits from your insurer shows what your plan allowed and paid, and it is not a bill. Match the two line by line before you pay, and question anything that does not agree.
Last updated .
Key facts
Insured adults who got a bill they thought should have been free or covered
- What it says
- 45%
- Applies to
- Insured US adults aged 19-64
- As of
| Fact | What it says | Applies to | Source | As of |
|---|---|---|---|---|
| Insured adults who got a bill they thought should have been free or covered | 45% | Insured US adults aged 19-64 |
A sample bill and explanation of benefits, explained
The sample below is made up: no real person, hospital or insurer. The numbered notes point to the parts people ask about most, and the table after it says what each part is and what to check.
Lakeside Community Hospital
100 Sample Way, Anytown, ST 00000
Statement date: 03/14/2026
Account no. 000-123456Note 1
Patient: [Your name]
| Date of serviceNote 2 | CodeNote 3 | Description | ChargesNote 4 |
|---|---|---|---|
02/03/2026 | 99284 | Emergency department visit | $1,850.00 |
02/03/2026 | 71046 | Chest X-ray, 2 views | $420.00 |
02/03/2026 | 85025 | Blood count (CBC) | $96.00 |
02/03/2026 | J1885 | Injection, ketorolac | $64.00 |
| Total charges | $2,430.00 | ||
| Insurance paymentsNote 5 | -$999.40 | ||
| Adjustments | -$1,092.00 | ||
| Amount you oweNote 6 | $338.60 | ||
Please pay by 04/13/2026
Need help paying this bill? You may qualify for financial assistance. Call (555) 010-0199 or visit lakeside.example/assistance.Note 7
Sample Health Plan
Explanation of benefits
THIS IS NOT A BILLNote 8
Claim no. 0000-0000 · Provider: Lakeside Community Hospital
| Service | Billed | AllowedNote 9 | Plan paid | You may oweNote 10 | RemarkNote 11 |
|---|---|---|---|---|---|
| ER visit | $1,850.00 | $1,020.00 | $745.00 | $275.00 | A1 |
| Chest X-ray | $420.00 | $210.00 | $168.00 | $42.00 | A1 |
| Blood count | $96.00 | $48.00 | $38.40 | $9.60 | A1 |
| Injection | $64.00 | $60.00 | $48.00 | $12.00 | A1 |
| Total | $2,430.00 | $1,338.00 | $999.40 | $338.60 |
A1: Amount applied to your deductible and coinsurance.
| Note | What it is | What to check |
|---|---|---|
| 1 | Account numberThe hospital's number for your bill. | Use it every time you call or write. Check that the name and address are yours. |
| 2 | Date of serviceThe day you got the care. | Match it with your own records and with the explanation of benefits. |
| 3 | Billing codeThe code for each service, test or supply (a CPT or HCPCS code). | Look for services you did not get, or the same code twice. |
| 4 | ChargesThe hospital's full price, before insurance and discounts. | Ask for a full list of charges if you see only totals. |
| 5 | Payments and adjustmentsWhat insurance paid, and what the hospital took off. | These should match the explanation of benefits. |
| 6 | Amount you oweWhat the hospital says you still owe, and the date it is due. | Before you pay, check it against the explanation of benefits and ask about financial assistance. |
| 7 | Financial assistance noticeNonprofit hospitals must tell you on the bill how to ask for financial assistance. | Call the number or visit the website it gives, and ask for the policy and the application. |
| 8 | This is not a billThe explanation of benefits comes from your insurer. It shows what it paid. | Wait for the hospital's bill; never pay from this page. |
| 9 | Allowed amountThe price your insurer agreed to for each service. | If you are in network, the hospital usually cannot bill you above this amount. |
| 10 | What you may oweYour share after your deductible, copay or coinsurance. | This should match the amount you owe on the hospital's bill. |
| 11 | Remark codeA short code that explains why something was reduced or denied. | Look it up at the bottom of the page. A denial can be appealed. |
What is the difference between the bill and the EOB?
| Question | The bill | The explanation of benefits (EOB) |
|---|---|---|
Who sends it | The hospital, doctor or lab | Your health insurer |
What it shows | What the provider charged, what insurance paid and what it says you owe | What the plan allowed for each service, what it paid and what you may owe |
Is it a bill? | Yes | No. It usually says "This is not a bill" |
What to do | Check it against the EOB before you pay | Keep it, and compare it with the bill when the bill arrives |
If you have no insurance, you will get only the bill. Check it line by line, and ask for the itemized bill if it shows only totals.
Words you will see on both
- Charges. The provider's full price before insurance and discounts.
- Allowed amount. The price your insurer has agreed to pay for a service. If a provider in your plan's network bills you more than this, ask your insurer why before you pay.
- Adjustment. An amount the provider takes off the charges, often the difference between the charges and the allowed amount.
- Deductible. What you pay each year before your plan starts to pay its share.
- Copay. A fixed amount you pay for a visit or a service.
- Coinsurance. Your share of the allowed amount, as a percentage, after the deductible.
- Balance due. What the provider says you still owe.
Which codes to check
- Procedure codes. Each service, test or supply has a code, such as a CPT code. The same code twice on the same day, or a code for care you did not get, is worth a question.
- Diagnosis codes. They say why you got the care. A wrong diagnosis code can make your plan refuse to pay.
- Remark codes on the EOB. Short codes that explain why a service was reduced or denied. The meaning is usually at the bottom of the EOB. A denial can be appealed.
Hospitals bill insurers on a form called the UB-04, and doctors on the CMS-1500. You can ask for a copy: your billing and payment records are covered by your right of access to your records Source 2.
Questions to ask before you pay
- Do the dates, the services and the codes match the care I got?
- Does the amount I owe on the bill match "what you may owe" on the EOB?
- Was the claim sent to my insurer, and did the insurer process it?
- Was any service denied, and why?
- Can I get an itemized bill?
- Do you have financial assistance, and how do I apply?
- Can I have an interest-free payment plan?
If something looks wrong
You are not alone. In one national survey, many insured working-age adults had received a bill or copay in the past year for a service they thought should have been free or covered. Their share was 45% (Commonwealth Fund, Gupta et al., April 18 to July 31, 2023). Among those who challenged one, the share who got it reduced or removed was 38% (Commonwealth Fund, Gupta et al., April 18 to July 31, 2023).
If the bill is for out-of-network care you did not choose, such as emergency care, the No Surprises Act may protect you if you have insurance Source 3. Our guides on medical billing errors and how to negotiate a medical bill have the next steps, and if you can't pay what is left, read about charity care.
Next step
If you need help with your own situation, these can help:
Sources
Note 1 Commonwealth Fund, Gupta et al., "Unforeseen Health Care Bills and Coverage Denials by Health Insurers in the U.S.". Published August 1, 2024. Last checked November 2, 2026.
Note 2 HHS, HIPAA right of access guidance. Published 2026. Not every state requires an itemized bill; these are the rights we could confirm. Last checked November 2, 2026.
Note 3 CMS, "Medical bill rights". Published October 5, 2026. Last checked November 2, 2026.
No changes since this page was first published.
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