How to Read and Understand a Medical Bill, Section by Section

To read a medical bill, find five things: who's billing you, the patient and account number, the dates of service, the list of charges with their codes, and the payments and adjustments that lead to the balance you owe. Your Medicare Summary Notice (MSN) is a separate notice, and Medicare.gov says it isn't a bill. Read the two side by side: the MSN shows what Medicare approved and the most you may be billed, and the provider's bill should match it.

Who is this bill from?

Look at the top of the bill for the provider's name. One hospital visit may produce several bills: one from the hospital and others from doctors, labs, or imaging groups that bill on their own. If you don't recognize the name, check the dates of service. It may be a doctor who treated you during a hospital stay.

What are the patient and account details?

Near the top you'll usually see:

• Patient name. Make sure it's the right person, especially in families with similar names.
• Account or invoice number. Use it every time you call or write.
• Statement date and due date. The due date matters, but you can ask to hold the bill while you review it.
• Insurance on file. Check that your Medicare and any Medigap or other plan are listed correctly. Wrong insurance information can make a bill higher than expected.

What do the dates of service tell me?

Each charge should have a date. Compare these to your calendar or notes. A charge on a day you weren't seen is worth questioning. For a hospital stay, check that the admission and discharge dates look right.

What do the codes and descriptions mean?

Itemized bills list each service with a short description and a code. Medicare and other payers use the Healthcare Common Procedure Coding System (HCPCS). The Centers for Medicare & Medicaid Services (CMS) says Level I of HCPCS is made up of CPT codes, used for services like office visits and procedures, and Level II is used mainly for products, supplies, and services not included in CPT, like medical equipment.

You don't need to know every code. Use them to:

• Spot the same code listed twice on one day.
• Ask what a code means if the description is unclear.
• Check that a visit code fits the visit you had.

See what a CPT code is and how to look one up.

If your bill has only a total, ask for an itemized one. See how to ask for an itemized hospital bill.

What are charges, adjustments, and payments?

Many bills walk from the full price down to what you owe, with lines like these:

• Charges. The provider's full price for each service. It can be much higher than what Medicare approves.
• Insurance payments. What Medicare and any other plan paid.
• Adjustments. Amounts the provider wrote off, for example because they accept Medicare's approved amount. Medicare.gov says providers who accept assignment agree to take the Medicare-approved amount as full payment.
• Patient payments. Anything you already paid.
• Balance or amount due. What the provider says you owe now.

If you see a big charge with no insurance payment or adjustment, the claim may not have been processed yet. Ask before paying.

How do I check the balance against my Medicare notice?

Your MSN lists, for each service, what Medicare approved, what it paid, and the "maximum you may be billed." With Original Medicare:

• If the provider accepts assignment, the balance shouldn't be more than that maximum.
• If you have Medigap or other coverage, the balance may drop further once they pay.
• If you're in the Qualified Medicare Beneficiary (QMB) program, Medicare.gov says Medicare providers aren't allowed to bill you for Medicare deductibles, coinsurance, or copayments on covered services.

Line up each bill line with the matching MSN line. How to read your Medicare Summary Notice explains the MSN columns. If you have Medicare Advantage, use your plan's Explanation of Benefits instead.

What should make me take a closer look?

• A balance higher than "maximum you may be billed."
• Two lines with the same code and date.
• Services you don't remember.
• No insurance payment shown.
• Old insurance listed.
• A "final notice" for a bill you never got before.

Common medical billing errors seniors should check for covers what to do about each.

What do I say if something doesn't make sense?

"I'm looking at the bill for account [number]. Can you explain line [number], code [code], on [date]? I don't see a matching payment from Medicare. Has the claim been sent to Medicare and to my [Medigap/other plan]? Please hold the account while I check."

Frequently asked questions

Is my Medicare Summary Notice a bill?

No. Medicare.gov says the MSN isn't a bill. It shows what Medicare paid and the most a provider may bill you.

What's the difference between charges and the amount due?

Charges are the provider's full prices. The amount due is what's left after insurance payments and adjustments.

Why does my bill have codes?

Codes identify each service and item. Medicare and other payers use them to process claims.

What if my bill only shows a total?

Ask the provider for an itemized bill that lists each charge, date, and code.

Want a plain-English read of your bill?

Bill Review Coach is a monthly medical bill review service for seniors and their families. Upload your first bill free, no card needed. Snap a photo of the bill and your Medicare notice, and you'll get back a plain-English summary of what each part means, what may be wrong, and what to ask. Refer a friend and you both get a free month once they join the paid plan. You make the calls and write the emails; we help you know what to say.