Before You Pay a Medical Bill in Maryland, Check These Things First

You have health insurance. Then a medical bill arrives, and the amount surprises you.

Before paying, check whether your insurance has processed the claim and whether the bill reflects your plan’s negotiated rate. You may still owe a deductible, copayment or coinsurance. But you should understand the amount before paying it.

Don’t ignore the bill. Ask questions, keep records and watch payment and appeal deadlines.

Start with your insurance statement

Your insurer’s Explanation of Benefits, or EOB, explains how it processed the claim, including the provider’s charge, the plan’s payment and your share. The EOB itself is not a bill.

Compare it with the provider’s statement. Check the service date, the balance and payments you already made.

Ask the billing office:

• Has my insurance finished processing this claim?
• Were the applicable network discounts and adjustments applied?
• Does this balance match my EOB, after accounting for my payments?

Understand the contractual discount

An in-network provider generally agrees to accept your plan’s negotiated amount for covered services. The difference between its original charge and that amount is a contractual adjustment, not an extra charge you automatically owe.

For example, suppose a covered service is billed at $1,000, but the allowed amount is $600. If your deductible is already met and your share is 20%, you would owe $120 and the insurer would pay $480. The $400 adjustment would not become an additional bill to you.

This is only an illustration. Your actual responsibility depends on your plan and the services received.

Before a planned procedure, make three calls

For scheduled, nonemergency care, contact:

1. The hospital or facility’s billing office.

   Ask for a written estimate and whether the facility is in your plan’s network. Find out which charges the estimate includes.

2. The doctor’s office.

   Ask for the procedure codes, whether the doctor is in network, and who else may bill you. Anesthesia, imaging, laboratory work or other services may generate separate bills.

3. Your insurance company.

   Confirm whether the procedure is covered, whether a referral or prior authorization is required, how much deductible remains and your estimated out-of-pocket cost. Verify each provider’s network status with the insurer.

An estimate helps you plan, but the final cost can change. Prior authorization does not guarantee that every charge will be covered.

Know Maryland’s protections

Maryland hospitals must provide written estimates of total charges for nonemergency services upon request. Those total charges are not necessarily your share after insurance. Hospitals must also provide an itemized bill within 30 days of a request.

Federal surprise-billing protections cover many emergency services and certain out-of-network services at in-network hospitals and surgery centers. Your normal in-network cost sharing may still apply. These protections do not cover every unexpected bill.

Maryland provides additional protections for some state-regulated plans. Self-funded employer plans, Medicare and Medicaid can follow different rules.

Maryland updated hospital financial-assistance and medical-debt regulations in December 2025. If a hospital bill is unaffordable, ask about financial assistance and payment options.

If the numbers don’t match

Request an itemized bill and contact both the provider and insurer. Ask whether the disputed balance can be placed on hold during review, and request written confirmation. A review request does not automatically suspend deadlines.

For help with a billing problem, contact Maryland’s Health Education and Advocacy Unit at 1-877-261-8807.

Never delay emergency care to research prices. For planned care, a few questions beforehand and a careful bill review afterward can help you avoid paying more than you owe.

Official sources

• Maryland Insurance Administration, Understanding your EOB
• Maryland Attorney General, Understanding Medical Bills
• Maryland Attorney General, No Surprises Act and hospital estimates
• Maryland Insurance Administration, Federal No Surprises Act
• CMS, Comparing healthcare costs
• Maryland Health Connection, Preauthorization
• Maryland HSCRC, Hospital financial assistance