Medical billing error
Bill Exceeds Your EOB
The hospital is billing you more than your insurer's Explanation of Benefits assigned as your responsibility.
Rule cited in the dispute letter: ERISA § 503 — 29 CFR § 2560.503-1; state insurance code
What an EOB tells you
After a claim is processed, your insurer sends an Explanation of Benefits showing the billed amount, the insurer-allowed amount (the negotiated rate the in-network provider agreed to accept), the insurer payment, and your patient responsibility (deductible + co-insurance + co-pay). The hospital can only bill you the patient-responsibility amount — billing more violates their in-network contract.
How to spot the violation
Compare each line on the hospital bill to the corresponding line on the EOB. Any line where the hospital is charging more than the EOB-assigned patient responsibility is presumptive balance-billing. This is one of the easiest disputes to win because it is a documented contract violation.
How to dispute
The dispute letter encloses the EOB, identifies each mismatched line, asserts that billing above the EOB amount violates the in-network contract, and requests a corrected statement matching the EOB. Copy your insurer's member services so they can apply pressure too.
Frequently asked
What if the hospital says the insurer "denied" the claim?
A denied claim should appear on the EOB as denied. If the EOB shows the claim processed with an allowed amount, the hospital cannot bill more than the patient-responsibility amount.
What about out-of-network providers?
Out-of-network providers are not bound by an in-network contract and can balance-bill — except where the No Surprises Act protection applies (see the NSA section).
Related guides
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