Your insurance processing a claim doesn't mean they paid everything. You likely still owe money due to your deductible, coinsurance, or copay.

Here's what happened: Your insurance negotiated the price down (that's the "allowed amount"), then determined what portion you're responsible for based on your plan. If you haven't met your deductible yet, you might pay 100% of the allowed amount even though insurance "processed" the claim.

What to do: Compare your bill to your EOB (Explanation of Benefits). The "patient responsibility" amount should match your bill. If it doesn't, call both your insurance and the provider.

Trust your instincts—up to 80% of medical bills contain errors.

First, request an itemized bill. Call billing and ask for a complete line-by-line breakdown with dates, CPT codes, and individual prices. Then look for duplicate charges, services you didn't receive, or incorrect quantities.

Compare your bill to your EOB. If your bill is higher than the "patient responsibility" shown on your insurance's Explanation of Benefits, something's wrong.

Dispute specific charges in writing. Don't pay amounts you're actively disputing. List the exact charges you're questioning with dates and reasons, and send this to the billing office.

Common denial reasons include coding errors, missing prior authorization, services deemed "not medically necessary," or out-of-network providers. The good news? About 80% of appeals succeed.

To appeal: Get the specific denial reason from your EOB. Gather supporting documents (medical records, doctor's letter explaining why the service was necessary). Write a brief appeal letter with your policy number, claim number, and why the denial is wrong. Submit it according to the instructions on your EOB.

Follow up weekly and don't give up after the first denial. Most insurance offers multiple appeal levels, including an external review by an independent third party.

In-network providers have contracts with your insurance. They accept negotiated rates and can't charge you more than your plan's cost-sharing (copay, coinsurance, deductible).

Out-of-network providers have no contract. They can charge full price and "balance bill" you for the difference between their charge and what insurance pays. This can cost you thousands more.

Example: An in-network MRI might cost you $180 (your 20% coinsurance of the $900 negotiated rate). The same MRI out-of-network could cost you $2,000 because the provider charges $2,500 and your insurance only covers a portion.

Always verify providers are in-network before receiving care—including anesthesiologists, radiologists, and labs involved in your treatment.

Deductible: The amount you pay each year before insurance starts covering costs. Resets annually (usually January 1st).

Copay: A fixed dollar amount you pay for specific services (like $30 for a doctor visit or $10 for a prescription). You pay this regardless of the actual cost.

Coinsurance: A percentage you pay after meeting your deductible (like 20%). If a procedure costs $5,000 and you have 20% coinsurance, you pay $1,000.

Out-of-pocket maximum: The most you'll pay in a year. Once you hit this, insurance covers 100% of covered services.

Balance billing is when a provider bills you for the difference between what they charge and what your insurance pays. It can result in massive surprise bills.

Under the No Surprises Act (2022), balance billing is illegal for:

• Emergency care at out-of-network facilities
• Out-of-network providers at in-network facilities (like anesthesiologists during surgery)
• Any situation where you didn't have a choice and didn't consent in writing 72 hours in advance

If you receive an improper balance bill: Contact your insurance immediately, file a complaint at cms.gov/nosurprises, and dispute the charges in writing. Don't pay it—paying can waive your right to dispute.

Yes. Almost every hospital offers payment plans, and many have financial assistance programs that can reduce or eliminate your bill.

Payment plans: Call billing and ask what options they offer. Many provide interest-free plans for 12-24 months with monthly payments as low as $25-50. If the payment is too high, negotiate a lower monthly amount.

Financial assistance/charity care: Non-profit hospitals often forgive bills for patients earning below 2-4x the federal poverty level. Ask billing: "Do you have a financial assistance policy? How do I apply?" You'll need to provide income documentation, but you could get 50-100% of your bill forgiven.

Don't be embarrassed to ask—these programs exist to help, and millions use them.

This is frustratingly common. Bills can arrive 3-12 months after your appointment due to:

• Insurance processing delays: Claims take 30-60 days to process normally, longer if there are errors or denials that need resubmission.
• Out-of-network providers you didn't know about: Anesthesiologists, radiologists, or labs often bill separately and months later.
• Provider billing delays: Some offices batch bills monthly or quarterly instead of sending them promptly.

What to do: Verify the bill is legitimate by checking with your insurance. If it arrives more than 12 months after service, check if it's past your state's "timely filing" deadline—the provider may have missed their window to bill you. Don't ignore it, but don't automatically pay without verifying it's correct.

Request a "good faith estimate" from your provider before receiving care. Under federal law, they must provide cost estimates including all providers involved (surgeon, anesthesia, facility, labs).

Verify network status: Call your insurance and ask: "Is [provider name and location] in-network for my plan?" Do this before every appointment.

Check if prior authorization is needed: Ask your insurance if your procedure requires approval beforehand. If it does, make sure your doctor submits for authorization—without it, your claim could be denied entirely.

Get a benefits verification: For major procedures, call your insurance and ask them to verify coverage for the specific CPT codes and providers. Get a reference number for this call.

Bottom line: You have the right to know what you'll pay before receiving care. If providers or insurers won't tell you, that's a red flag.

When your provider and insurance can't agree, you shouldn't have to pay for their dispute.

First steps:

• Call your insurance and get the specific reason for the denial or partial payment
• Call the provider and ask them to work directly with insurance to resolve it
• Request a three-way call with both parties on the line

Escalate if needed:

• File a complaint with your state's Department of Insurance
• Contact the patient advocate at both your insurance company and the provider
• Request an independent external review (a neutral third party will make a binding decision)

Put it in writing: Send a letter to both parties stating you're disputing the bill and requesting they resolve it without further billing you. Send via certified mail.

While the dispute is ongoing: Don't ignore the bill, but don't pay the disputed amount either. Request in writing that collections be held while the issue is resolved.