Medical Bills After an Injury: Questions to Ask

After an injury, the bills often arrive before anyone explains them. A single visit can produce a statement from the hospital, a separate one from the doctor, another from the radiology group, and a bill for medication. Each one may use different codes, different totals, and different payment deadlines. Asking the right questions early makes the picture much clearer.

This page is general information about how bills work. It does not tell you how a particular bill should be handled.

Start with the itemized bill

A summary bill shows a total. An itemized bill lists each service, test, medication, and supply, with the date and the charge. Ask for an itemized bill from every provider. Check that the dates match the visits you remember. Look for duplicate charges, tests you did not receive, and services listed under the wrong patient.

If something does not match, ask the billing office to explain it in writing. Keep copies of everything you send and receive.

Read the explanation of benefits

An explanation of benefits, often called an EOB, comes from your health insurer. It is not a bill. It shows what the provider charged, what the insurer allowed, what it paid, and what it says you owe. Compare the EOB with the provider's bill. If the numbers differ, ask both the provider and the insurer why.

Some people also receive EOBs from an auto or liability insurer when a claim is open. Keep them in the same file.

Questions for the provider

When you call the billing office, ask:

• Is this provider in my health plan's network?
• What code or service does this charge describe?
• Has this been sent to my insurer, and what did the insurer pay?
• Is there a balance, and by what date is payment expected?
• Do you have a financial assistance or charity care program, and how do I apply?
• Can I set up a payment plan?
• Will you hold the account while an insurance claim is pending?

Write down the name of the person you spoke with, the date, and what they said.

Questions for your health insurer

Ask your insurer:

• Which services did you approve, and which did you deny or hold for review?
• What is my deductible and out-of-pocket amount for this year, and how much has been used?
• Was a prior authorization needed for any of these services?
• How can I appeal a denial, and what is the deadline for an appeal?

A denial should come with a written notice. Read that notice carefully, because it describes the reason for the denial and the appeal steps and deadlines.

When an injury claim is involved

If another person or a business caused the injury, the medical bills may be part of a claim. Some health insurers and medical providers have a right to be repaid from a settlement. These claims are sometimes called liens. Ask the provider and the insurer whether they have filed a lien or expect repayment from a settlement, and keep the answer in writing.

Do not pay large amounts without understanding what they cover and whether the claim changes the balance.

Watch for common problems

Some issues come up often:

• a provider outside the network billed as if it were in network;
• a bill sent to collections while an insurance appeal is still open;
• charges for a service that was bundled into another charge;
• a balance that increases because of a late fee added during a dispute.

Ask the provider to correct errors, and ask for a written hold while you check the account. If a bill goes to collections, you can ask the collector to validate the debt, which means showing proof that you owe the amount. The Consumer Financial Protection Bureau explains how to respond to a debt collector.

Keep your own list

Make a table with the date, provider, service, amount billed, amount paid by insurance, and amount you owe. Add a column for the status of each question. This list helps you see patterns, and it helps a lawyer or financial counselor understand the costs quickly.

Where to get more help

Some hospitals have patient financial counselors. Nonprofit credit counseling agencies may help with payment plans. For legal questions about a claim, a licensed attorney in your state can explain what applies to you. You can also read the guides hub for plain-language articles on the claims process, and the personal injury practice page for lawyers who handle injury claims.

Frequently asked questions

Do I have to pay a bill that my insurer has not finished reviewing? Ask the provider to place the account on hold while the review continues. Many providers will do this when you ask in writing, but policies vary.

What does "balance billing" mean? It means a provider bills you for the difference between its charge and the amount the insurer allowed. Whether this is allowed depends on your plan, your network status, and your state. Ask your insurer and the provider to explain the amount in writing.

Can I negotiate a medical bill? Many providers will discuss a reduced payment, a payment plan, or financial assistance. Ask before you pay, and get any agreement in writing.

What if a bill was sent to collections? Ask for proof of the debt, and tell the collector in writing if you dispute it. A lawyer can explain your options under federal and state debt collection rules.

General information, not legal advice. Laws change and every case is different. Talk to a licensed attorney in your state about your situation.