When a delivery bill lands on your doorstep: start here
Giving birth is expensive — and emotionally exhausting. Getting an unexpected bill weeks later can feel crushing. The first step is not to panic: most surprise charges can be investigated, appealed, or negotiated. This article walks you through how to read your health plan’s Explanation of Benefits (EOB), what to do the moment you see a surprise balance after delivery, how appeals and the federal Independent Dispute Resolution (IDR) process work, and how to use patient‑advocacy services so you don’t pay more than you should.
An EOB is a summary from your insurer explaining what was billed and what the plan paid (it is not the provider’s bill). Read it carefully and use it as your roadmap for any appeal or dispute.
How to read an EOB — what each line usually means
Before you call anyone, compare the EOB and the bill you received. The EOB breaks down the insurer’s view of the claim; the provider’s bill is the (possible) request for payment. Common EOB sections and what to look for:
- Patient and claim info: name, member ID, claim number and date of service — use the claim number when you call the insurer.
- Provider charges: the price the hospital or clinician billed.
- Allowed (or negotiated) amount: what the insurer says is the allowable amount after in‑network discounts — this is often lower than the provider charge.
- Paid by insurer: how much the plan paid to the provider.
- What you owe / patient responsibility: co‑pay, coinsurance, deductible amounts, and any remaining balance.
- Remark or denial codes: short codes that explain denials, reductions, or why an item was processed a certain way — look for an explanation on the back or at the bottom of the EOB.
Tip: If your provider’s bill is higher than the EOB’s "What You Owe" number, do not pay until you confirm why — there may be a billing error or a timing issue.
Immediate checklist — first 7 days after you get the bill or EOB
- Match claims and dates: Confirm the date of delivery and all services (ER, anesthesia, radiology, newborn care) on both EOB and provider bill.
- Call the hospital/provider billing office: Ask for an itemized bill and whether any provider on the claim (e.g., anesthesiologist, pathologist, radiologist) was out‑of‑network. Many surprise bills arise from an OON clinician who works at an in‑network hospital.
- Call your insurer’s claims department: Use the phone number on your insurance card or the EOB. Ask why the insurer paid the amount shown, whether the provider was listed as in‑network at time of service, and whether the No Surprises Act protections apply.
- Put key facts in writing: Save EOBs, the itemized bill, notes with dates/times of calls, and the names and extension numbers of anyone you spoke with.
- Ask about hospital financial assistance: Many hospitals offer charity care or sliding‑scale help for families who qualify — this can pause collections while you apply.
If the insurer or provider says you may have a "surprise bill," you can contact the No Surprises Help Desk for guidance and to submit a complaint; this help desk is available to explain your rights and how to proceed.
Appeals and dispute options: internal appeals, external review, and IDR
If the claim was denied or an out‑of‑network provider billed you more than the EOB allows, you have several formal paths:
- Internal appeal with your plan: If you disagree with your plan’s payment or denial, file an internal appeal following the insurer’s written process (request that process if you don’t have it). Insurers are required to respond within specified timeframes under federal and state rules.
- External review where available: State external review or independent review organizations can review coverage denials; check your plan documents or state insurance department for details.
- Federal IDR process (No Surprises Act): For eligible surprise bills involving emergency care or certain out‑of‑network services at in‑network facilities, the No Surprises Act keeps the patient out of negotiation and lets providers and plans use an independent arbitrator (IDR) if negotiations fail. The IDR system has specific rules about eligibility, batching of line items, timelines, and administrative fees; CMS publishes guidance and data on how the process works. Use the IDR process only after you confirm eligibility with the plan and provider.
Important: If you file a complaint with the No Surprises portal or the help desk, providers generally cannot send the bill to collections or impose late fees while the complaint is pending — save your documentation and include it with any appeals.
Use advocates, state help, and consumer agencies
Don’t go it alone. There are organizations that will help you navigate appeals, apply for financial assistance, and negotiate with billing departments:
- Hospital or health system patient advocate: Most hospitals have an internal patient or billing advocate who can explain charges, identify errors, and help with charity applications.
- Patient Advocate Foundation: A nonprofit that offers case management and assistance applying for financial help and appealing insurance denials; they also provide guidance for complex billing problems. Contact them for one‑on‑one help if you meet eligibility criteria.
- State consumer assistance programs: Your state insurance department or consumer assistance program can advise on appeals and state law protections; use the NAIC site or your state DFS/insurance office.
- Federal help and consumer agencies: The No Surprises Help Desk (federal) and the Consumer Financial Protection Bureau (CFPB) can help if a provider or collector tries to report a prohibited debt to credit bureaus or engage in unlawful collections. CFPB has issued guidance warning debt collectors and credit bureaus about debts that are barred under the No Surprises Act.
Practical tip: If a bill is in collections that you believe is unlawful under the No Surprises Act, file a complaint with CFPB and keep copies of your EOB and communications — this can stop or reverse credit reporting in some cases.
How to prepare an insurance appeal or IDR packet — checklist
Whether you file an internal appeal or support a provider‑initiated IDR, collect the following:
| Document | Why it matters |
|---|
| Copy of EOB(s) | Shows insurer’s determination and patient responsibility. |
| Itemized provider bill | Shows billed codes and charges to compare against the EOB. |
| Medical records & operative notes | Proves medical necessity and chronology of care. |
| Your notes of phone calls | Names, dates, and times of conversations with billing/claims reps. |
| Copies of prior authorizations or in‑network confirmations | Can show coverage or that you relied on in‑network status. |
Send appeals by certified mail or using the insurer’s specified portal, and request written confirmation of receipt. Keep clear timelines — many programs set strict windows for filing appeals or complaints.
Negotiation scripts and practical next steps
If appeals are slow or you seek a quick resolution, try negotiation with the provider’s billing office. Use short, factual scripts and offer options:
- "I’m reviewing these charges with my insurer. Can you place this account on hold while we resolve the claim?"
- "I can’t pay this balance in full. Do you offer a financial assistance application or interest‑free payment plan?"
- "I believe this may be a surprise bill under federal/state law. Can billing suspend collections while we file a dispute?"
Keep everything in writing and get any settlement or payment‑plan agreement by email. If a debt collector calls, request validation in writing and tell them you are disputing the debt while you pursue appeals under insurance and the No Surprises Act. If collections or credit reporting occur on a debt you believe is protected, file a complaint with CFPB.
Bottom line: be methodical, gather documents, use the EOB as your guide, and loop in patient advocates or state/federal help if needed. Resources and laws (including IDR procedures) have evolved since the No Surprises Act launched in 2022, and agencies like CMS and KFF publish ongoing guidance and performance updates that may affect timelines and eligibility, so check authoritative sites while you work your case.
Quick resource list — who to call and when
- No Surprises Help Desk: 1‑800‑985‑3059 (for questions and to file a federal complaint).
- Patient Advocate Foundation: case management & financial navigation — (800) 532‑5274.
- CFPB consumer complaint: (855) 411‑2372 or online — for unlawful collections or credit reporting.
- Your state insurance department or consumer assistance program — search via the National Association of Insurance Commissioners (NAIC) or your state DFS.
If you’d like, we can create a one‑page checklist you can print and bring to calls with the hospital or insurer. Or tell us your state and we’ll point you to the right state insurance office and charity resources.
