The Anatomy of a Medical Bill and an EOB

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Hospital Bill

What the Hospital Is Asking For

1. Billed Charges
What the hospital lists as the total cost of care.
This is not what most people actually pay.

2. Insurance Adjustments
The portion reduced based on the insurance contract.

3. Insurance Payment
What the insurance company paid the hospital.

4. Current Balance
What the hospital says the patient owes after insurance.

Key takeaway:
A hospital bill shows the hospital’s side of the transaction.

Explanation of Benefits (EOB)

What the Insurance Says

1. Service / Product/ Care Received
What was reviewed by insurance.

2. Your Responsibility
Deductible, copay, or coinsurance amounts.

3. Provider Charges
What the provider billed insurance.

4. Paid by Insurer
What the insurance plan approved and paid.

Important:
An EOB is not a bill. It explains how insurance processed the claim.

Key takeaway:
The EOB shows the insurance side of the transaction.

The hospital bill and the EOB should tell the same story.
When they don’t, ASK FOR CLARIFICATION.

Here is a script to get you started:

Calling the hospital billing office

“Hi, I’m calling about my bill for [date of service]. My hospital bill and my EOB don’t match, and I need clarification before I pay.

Can you confirm the claim number and the exact amount you show as my current balance after insurance?

Also, can you send me an itemized statement and explain what this charge/adjustment represents: [line item or amount]?”

Calling the insurance plan

“Hi, I’m calling about a claim for [date of service] with [provider/facility]. My EOB and the hospital bill don’t match.

Can you confirm the allowed amount, what was paid, and what you show as patient responsibility?

Was the claim processed in-network, and was anything denied or applied to deductible or coinsurance?”

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