Your insurer’s Explanation of Benefits (EOB) is not a bill — it’s the insurer’s statement of what was billed, what the plan allowed, what it paid, and what you actually owe. When the provider’s bill is higher than the “patient responsibility” on the EOB, something is off: the claim may not have been billed to insurance, an in-network discount may be missing, or you’re being charged the full (non-discounted) rate.
Before you write
Line up the two documents and compare the patient responsibility on the EOB with the amount due on the bill, for the same date(s) of service. Note any difference, and check whether the EOB shows the claim was processed at all.
The letter
[Your full name]
[Your address]
[City, State ZIP]
[Phone] | [Email]
[Date]
[Provider billing department]
[Billing address]
Re: Bill does not match insurer's EOB
Patient: [Patient name, date of birth]
Account / Statement number: [number]
Insurer: [plan name] Member ID: [number] Claim #: [from EOB]
Date(s) of service: [dates]
To the billing department:
The amount you are billing me for the date(s) of service above does not match my
insurer's Explanation of Benefits for the same claim.
- Patient responsibility on the EOB: $[amount]
- Amount you are billing me: $[amount]
- Difference: $[amount]
Please reconcile this account with the processed EOB. Specifically:
- If the claim was not submitted to my insurer, please bill [insurer] first.
- If the in-network or contracted discount was not applied, please apply it.
- Then send me a corrected statement reflecting only the patient
responsibility shown on the EOB.
I have attached a copy of the EOB for this claim. I'll pay the correct patient
responsibility once the bill matches it. Please hold collection activity on the
disputed difference while this is reconciled.
Sincerely,
[Your signature]
[Your printed name]
How to send it
Attach the EOB (or the relevant page). Send via the portal or certified mail and keep copies. If the provider insists the EOB is wrong, the next step is usually an insurance issue — call your plan and, if needed, file an internal appeal.
Notes. If you were billed the full rate for an in-network provider, the missing contracted discount is often the whole problem. If the service was out-of-network or a “surprise” bill from an in-network facility, see the No Surprises Act dispute and balance-billing letters. General information, not legal advice; plan rules vary.