One of the most important things to understand about medical billing is the difference between an insurance statement and an actual bill.
If you have a Medicare Advantage plan, you may receive an Explanation of Benefits (EOB) after receiving medical care. If you have Original Medicare, you may receive a Medicare Summary Notice (MSN).
These documents explain how a claim was processed. They typically show:
- What the provider charged.
- What Medicare or your health plan allowed.
- What Medicare or the plan paid.
- What amount may be your responsibility.
- Whether any portion of the claim was denied.
An EOB or Medicare Summary Notice is generally not a bill.
A provider bill comes from the doctor’s office, hospital, laboratory, or other healthcare provider and requests payment.
When you receive a provider bill, compare it with your EOB or MSN before paying it. The amount the provider bills you should generally be consistent with the patient responsibility shown after the claim has been processed.
If the numbers do not match, contact the provider and your health plan before making payment.
If you have an EOB, Medicare Summary Notice, or provider bill that you do not understand, contact Regional Financial Security Agency. We can help you understand what the documents mean and what questions you should ask before paying.