Handle the bill while you appeal

Guides

• A bill is not an Explanation of Benefits: do not pay yet

  A provider's bill and your plan's Explanation of Benefits are different papers. Match them before you pay, ask for a hold in writing, and do not pay what your plan may owe.

• The bill while you appeal

  Appeals take months and the bill keeps coming. Ask the provider for a hold in writing, check the bill against your Explanation of Benefits, and do not pay what your plan may still owe.

Tools

• Tool

  Bill and statement reconciler

  Put your bill next to your Explanation of Benefits and see the mismatches to question.

• Tool

  Explanation of Benefits decoder

  Look up the lines and common codes on your statement and see whether you should pay yet.

• Tool

  Records and bill request builder

  Build requests for your medical records and an itemized bill.

• Tool

  Surprise bill checker

  See whether the federal No Surprises Act may protect you from an out-of-network bill, with three plain steps, a phone script and two letters.

Letters and scripts

• Letter or script

  Ask for an itemized bill

  A written request to a provider for an itemized statement of every charge, code, payment and adjustment on your account, so you can compare it with your plan's Explanation of Benefits before paying.

• Letter or script

  Ask the provider to hold the bill

  Ask a provider in writing to pause collection, interest and late fees on a bill while your insurance appeal is decided.

• Letter or script

  Phone script: first call to the billing office about a surprise bill

  What to say on your first call to a provider's billing office about a bill that may be a surprise bill: what to ask for, what to write down, how to ask for a hold in writing, and what to say if they mention collections.

• Letter or script

  Tell the provider the No Surprises Act may apply to your bill

  Write to the provider's billing office to say the federal No Surprises Act may apply, ask them to bill only your in-network share, hold the account while your plan reprocesses the claim, and confirm in writing.

Checklists

• Checklist

  The bill while you appeal

  How to keep a bill from getting worse while your appeal is pending, check what you actually owe, and look for ways to reduce it.

Programs and services

Run by other organizations.

• Program or service

  Consumer Financial Protection Bureau: what to do if you cannot pay a medical bill

  Federal consumer-bureau guidance on checking whether you owe a bill, looking for billing errors, using appeal rights, financial assistance and payment plans, and avoiding collections.

  From Consumer Financial Protection Bureau

• Program or service

  Medical Bill Rights: find an action plan for your medical bill

  A five-minute federal questionnaire about your billing problem that gives you suggested next steps, whether you already have a bill or are planning for care.

  From Centers for Medicare & Medicaid Services