After an MRI, CT or other scan, you may get several pieces of paper: an Explanation of Benefits from your insurer, a bill from the imaging center or hospital and sometimes a separate bill from the radiologist. They use different terms and the numbers rarely match at first glance. This guide shows you how to read them, how they fit together and what to do if something looks wrong.
Key takeaways
- An Explanation of Benefits (EOB) is not a bill. It shows what was charged, what your plan allowed and paid, and what you may owe.
- Wait for your EOB before paying an imaging bill, and compare the two. Your bill shouldn’t be higher than the amount the EOB says you owe.
- It’s common to get two bills for one scan: one for the facility (the scanner, staff and supplies) and one for the radiologist who reads the images.
- Check the date, the exam, the codes and whether contrast was used.
- If something is wrong, call the provider and your insurer first. You can ask for an itemized bill and appeal a denied claim.
EOB vs. bill: what’s the difference?
| Explanation of Benefits (EOB) | Bill (statement) | |
|---|---|---|
| Who sends it | Your insurance company | The imaging center, hospital or radiology group |
| Is it a request for payment? | No | Yes |
| What it shows | Charges, allowed amount, what the plan paid, what you may owe | What the provider says you owe now |
| What to do | Keep it and compare it with your bill | Pay only after checking it against the EOB |
If you have Original Medicare, you’ll get a Medicare Summary Notice (MSN) instead of an EOB. It’s also not a bill. It lists the services billed to Medicare, what Medicare paid and the most you may owe.
Key terms on your EOB
- Amount billed (provider charges): what the provider charged. This is often much higher than what anyone actually pays.
- Allowed amount: the price your plan agreed to with in-network providers, or the amount it recognizes for the service.
- Plan paid: what your insurer paid the provider.
- Deductible: the part of the allowed amount you pay before your plan starts paying.
- Copay or coinsurance: your share after the deductible, either a fixed amount or a percentage.
- What you owe (patient responsibility): the total you may owe the provider for that service.
- Not covered: an amount the plan won’t pay. Look for the reason.
- Remark or reason codes: short codes explaining a payment or denial, defined at the bottom or back of the EOB.
- Claim number: use it whenever you call your insurer.
Why you got two bills for one scan
Imaging charges often have two parts:
- The technical part: the scanner, the technologist, the room, supplies and contrast. The imaging center or hospital bills this.
- The professional part: the radiologist’s work reading the images and writing the report. The radiologist or their group often bills this separately.
On claims, these are sometimes marked with modifiers: TC for the technical part and 26 for the professional part. If one organization bills both together, you may see a single «global» charge instead.
If you have a hospital scan, you may also see a facility fee, and the hospital may use revenue codes along with the procedure code.
Codes to check
- CPT code: a five-digit code for the exact procedure. For example, 70551 is an MRI of the brain without contrast, and 73721 is an MRI of a lower-extremity joint, such as the knee, without contrast.
- With or without contrast: different codes and prices. Make sure the code matches what you actually had.
- Diagnosis code (ICD-10): explains why the scan was done. A wrong diagnosis code can lead to a denial, or to a screening exam being billed as diagnostic.
You don’t need to memorize codes. Just make sure the description matches the exam you had. If you’re not sure, ask the imaging center what was done.
A sample EOB, explained
The numbers below are hypothetical, to show how the pieces fit together. Assume a knee MRI without contrast at an in-network independent imaging center, with your deductible already met and 20% coinsurance.
| Service | Amount billed | Allowed amount | Plan paid | You owe |
|---|---|---|---|---|
| MRI knee without contrast, technical part (CPT 73721-TC), imaging center | $1,800 | $420 | $336 | $84 |
| MRI knee without contrast, radiologist reading (CPT 73721-26), radiology group | $350 | $70 | $56 | $14 |
| Total | $2,150 | $490 | $392 | $98 |
What this tells you:
- You should get two bills: about $84 from the imaging center and about $14 from the radiology group.
- Neither bill should ask for more than these amounts.
- The $1,800 and $350 «billed» amounts don’t matter to you, because the providers are in network and agreed to the allowed amounts.
Red flags to look for
- A bill that’s higher than «what you owe» on the EOB.
- A bill that arrives before your insurer has processed the claim.
- Duplicate charges for the same exam or date.
- Contrast billed when you didn’t receive any, or the wrong body part.
- A screening exam billed as diagnostic, such as a screening mammogram or lung screening CT.
- An out-of-network charge from a radiologist at an in-network hospital. In many cases, federal law protects you from these surprise bills.
- A denial for missing prior authorization that you believe was approved.
What to do if something looks wrong
- Compare the bill and the EOB line by line.
- Ask the provider for an itemized bill that lists each charge with its code.
- Call the provider’s billing office. Many errors are coding mistakes that can be corrected and resubmitted.
- Call your insurer with the claim number if you think the claim was processed incorrectly.
- File an appeal if the insurer denied coverage. The EOB or denial letter explains how.
- Get help with surprise bills from the federal No Surprises Help Desk at 1-800-985-3059.
- Ask about payment plans or financial assistance if the bill is correct but hard to afford. Many hospitals have financial assistance programs.
Keep notes of every call: the date, the person’s name and a reference number.
Frequently asked questions
Should I pay the bill before I get my EOB? It’s usually best to wait for the EOB so you know your correct share. If a provider asks for payment upfront, ask whether they’ll refund any overpayment.
Why is the «amount billed» so high? Providers set list prices that are much higher than what insurers pay. If you’re in network, you pay based on the allowed amount, not the billed amount.
Why did I get a bill from a radiologist I never met? The radiologist reads your images and writes the report, usually without meeting you. Their fee is often billed separately.
What if I don’t have insurance? You won’t get an EOB. Ask for a good faith estimate before your scan and an itemized bill afterward. Our self-pay guide explains how to ask for a cash price.
Sources
- Centers for Medicare & Medicaid Services (CMS): How to read a health insurance explanation of benefits.
- Medicare.gov: Medicare Summary Notice (MSN).
- CMS: Medical bill rights and the No Surprises Act.
- Iridium Suite: How to differentiate between global, professional and technical charges.
This article is for general information only and isn’t financial or legal advice. If you have questions about a specific bill, contact the provider and your insurer.