EOB vs. bill: how to tell if you're being double-charged

Two documents describe the same visit: the provider's bill and your insurer's Explanation of Benefits(EOB). They should tell the same story. When they don't, the gap is usually money you don't owe.

What an EOB is (and isn't)

An EOB is not a bill. It's your insurer's accounting of a claim: what the provider charged, what the plan allowed, what it paid, and what you owe. That last figure, patient responsibility, is the number that should match your bill.

How to compare them

• Line up the dates of service.Make sure you're comparing the same visit.
• Match patient responsibility to the balance due. If the bill asks for more than the EOB says you owe, question it.
• Watch for balance billing.Being charged the difference between the provider's charge and the allowed amount may be prohibited, especially under the No Surprises Act.
• Check that insurance was applied at all. A bill for the full charge often means the claim was never processed.

When they don't match

Call the provider with the EOB in hand and ask why the bill exceeds your stated patient responsibility. If they insist, escalate to your insurer. They have an interest in stopping a provider from over-collecting against a processed claim.