Your situation: You got a bill from an in-network provider
This action plan applies to you if:
- You got an unexpected medical bill
- You used health insurance
- You went to an in-network facility and received care from an in-network provider
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Action Plan
Unexpected high medical bills are frustrating. But there are steps you can take to reduce your costs.
Check your bill for errors.
Does your bill match what happened when you got care? Are you getting billed twice for the same thing or for services you didn’t get?
Compare the explanation of benefits from your health plan to your bill.
Look at the “What you owe” column in the explanation of benefits. It should be the same as the amount on your bill.
Learn how to read your explanation of benefits
Contact your health care provider if the explanation of benefits doesn’t match your bill.
Sometimes there are errors in the bill. You shouldn't have to pay more than what’s shown in the explanation of benefits.
File an internal appeal if your explanation of benefits matches your bill, but you still believe there has been an error.
Ask your insurance company to reconsider its decision. They must tell you why they’ve denied your claim or ended your coverage.
Learn how to file an internal appeal on HealthCare.gov
File an external review if you disagree with the results of the internal appeal.
Take your appeal to an independent third party for review. The review may cost up to $25.
Your health insurance company must accept the reviewer’s decision.
Note: You may need to go through another round of internal appeals before you begin an external review. And not all types of appeals are eligible.
Learn more about the external review process on HealthCare.gov
If you think your provider isn't following the law, submit a complaint.
When you submit a complaint, you're still responsible for paying the amount listed as "What you owe" in your explanation of benefits. But submitting a complaint will help us ensure that you and other patients aren't over charged in the future.
Get help from outside resources.
Here are other resources to help you resolve your issue:
Consumer Assistance Programs
Consumer Assistance Programs may be able to give you advice for your specific case in the state you got care.
Patient advocates
Patient advocates can handle medical billing issues on your behalf.
Friends and family
Consider asking a loved one for help. They can advocate on your behalf if you're feeling sick or overwhelmed.
Page Last Modified:
11/05/2024 03:38 PM