Inside Medicare | How do I know if my bills are actually correct?

Janell Sluga Medicare & Individual Health Insurance Account Executive View Bio

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Question:

I received a bill from a doctor for a procedure they performed. How do I know if the amount is correct, and what I actually need to pay?

Answer:

The key to maximizing your medical insurance coverage is first being sure providers (doctors, hospitals, pharmacies, labs, and more) have your CORRECT insurance on file. Many of you have changed your coverage for 2026 and your providers may have missed that change.

Each and every procedure, provider, hospital stay, etc. needs to be processed by your insurance carrier using the standards that your particular plan has.

When you receive a bill from your provider, I strongly encourage you to cross reference that bill with the Explanation of Benefits (EOB) you receive from your insurance carrier. Your insurance carrier mails the EOB’s out as services are processed, or in a monthly mailing.

If you use Original Medicare, a similar document is called a Medicare Summary Notice (MSN). Medicare has mailed the MSN’s out quarterly for many years. Medicare has just announced that it will begin sending these MSN twice yearly (every 6 months). I feel like that is a significant delay in finding out about the insurance decision, as your healthcare providers may not be willing to wait 6 months for you to pay the bill. Yet Medicare has made this decision to reduce the number of mailings of the MSN’s as a cost cutting measure.

If you want your MSN sooner than every six months, Medicare has advised that you can sign up to have them emailed to you as processed. You can also use the medicare.gov website to print them off or review them whenever you wish.

You can see that more and more of our interactions with companies and insurance is driving us to do business online. That works, as long as you have a computer or can get help from someone with a computer. For those of you that don’t use a computer, you can also call Medicare at 1-800-Medicare (800-633-4227), and from there you can request they mail you the specific MSN that you are looking for.

If you have secondary insurance like a Medicare Supplement, Medicare Advantage Plan, or Retiree benefits, your EOB is similar and it will come from the insurance carrier, not from Medicare.

If you find the doctor’s bill does not match your MSN or EOB, speak to the billing department at your doctor’s office. There may be a ‘crossing in the mail’ issue or another reason for a different amount. You can usually resolve the issue by talking with the billing person at the physician’s office. If you still can’t come to an agreement, you can always reach out to Medicare at 1-800-MEDICARE.

If you wanted to do some research for yourself, you can find out some of the costs for services covered in the Evidence of Coverage document that your insurance carrier sent to you. If you didn’t receive an Evidence of Coverage document, you can call and request that one be sent to you. You can also use your insurance carrier’s website to save it to your computer to review as needed.

The MSN or EOB would be the most accurate way of determining the correct cost for the procedure or service provided.

Never pay a bill without an MSN, or EOB’s to match it to. Sometimes providers send bills to you, before your insurance has had a chance to pay the bill on your behalf. I therefore want to stress again to never pay a medical bill without first comparing it to your MSN or EOB.

Many individuals pay bills as soon as they get them, and I do want to caution you about doing that without cross checking the information first. It will take you a long time to get the money back if you paid a bill you weren’t responsible to pay.

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email jsluga@lawleyinsurance.com.