How to Read and Understand Your Medical Bill

You may receive multiple bills for a single visit: facility/hospital fees, physician/professional fees, lab fees, radiology fees, anesthesia fees, and equipment or supply charges. Each may come from different billing entities even for the same visit.

CPT Codes are 5-digit numbers identifying specific services. Charges are the provider's list prices (often inflated). Adjustments are discounts from insurance contracts. Allowed Amount is the maximum your insurance pays. Patient Responsibility is what you owe after insurance.

Hospital-based facilities add facility fees on top of professional fees. These cover overhead, equipment, and nursing staff. Outpatient procedures at hospital-owned clinics often include these fees even for simple office visits.

Your Explanation of Benefits shows what your insurance processed. Compare Date of Service, Provider Name, Service Description, Billed Amount, Allowed Amount, Insurance Paid, and Your Responsibility. This is not a bill but tracks what insurance covered.

Watch for services on dates you weren't treated, duplicate line items with same CPT code and date, charges for consultations you don't remember, excessive quantities of supplies, and operating room time that seems too long.