ERPSav

Sample report · Medical Bill Review

$5,708.33 expected back from a 15-row sample

This is ERPSav's own engine run on the sample file. The figures come from sample data, not from a customer.
Rows read
15
Cases opened
5
Money at risk
$7,122.48

Cases

  • St. Mary's Regional Medical Center — 3 charges above the EOB, 1 payment not credited, 1 duplicate line, 1 implausible unit count, 1 charge after dischargeSt. Mary's Regional Medical Center

    $2,471.48of $2,942.48 at risk

    • blockerSt. Mary's Regional Medical Center billed $180.00 for 2026-08-04, code 36415 (Venipuncture), 6 units, billed $180.00, $172.80 more than the EOB patient responsibility of $7.20 for an in-network service.
    • blockerSt. Mary's Regional Medical Center billed $2,576.00 for 2026-08-03, code 74177 (CT abdomen and pelvis with contrast), 1 unit, billed $3,200.00, $2,420.00 more than the EOB patient responsibility of $156.00 for an in-network service.
    • blockerSt. Mary's Regional Medical Center billed $96.00 for 2026-08-07, code 80053 (Comprehensive metabolic panel), 1 unit, billed $96.00, $91.20 more than the EOB patient responsibility of $4.80 for an in-network service.
    • blockerSt. Mary's Regional Medical Center: a payment of $250.00 for 2026-08-03, code 99223 (Initial hospital care, high), 1 unit, billed $690.00 does not appear to be credited; the balance shown is $250.00 against $0.00 expected (EOB patient responsibility $250.00 less payments).
    • warningSt. Mary's Regional Medical Center lists code 85025 (CBC with differential) on 2026-08-03 with 1 unit more than once (lines 4 and 5), each billed $64.00; the repeat line asks you for $3.68.
    • warningSt. Mary's Regional Medical Center billed 6 units of code 36415 (Venipuncture) on 2026-08-04; more than 3 per day is unusual for this code, so $90.00 of the $180.00 asked of you is in question.
    • warningSt. Mary's Regional Medical Center charged code 80053 (Comprehensive metabolic panel) on 2026-08-07, after the discharge date of 2026-08-05; the line asks you for $96.00.

  • Aetna (No Surprises Act, Valley Anesthesia Associates) — 1 surprise out-of-network billAetna

    $1,350.00of $1,800.00 at risk

    • blockerValley Anesthesia Associates billed $1,920.00 for 2026-08-04, code 00790 (Anesthesia, upper abdominal procedure), 1 unit, billed $2,400.00, $1,800.00 above the EOB patient responsibility of $120.00. These are ancillary services by an out-of-network provider at an in-network facility, where the No Surprises Act limits the patient to in-network cost sharing.

  • Aetna (No Surprises Act, Lone Star Emergency Physicians) — 1 surprise out-of-network billAetna

    $1,232.00of $1,540.00 at risk

    • blockerLone Star Emergency Physicians billed $1,622.00 for 2026-08-03, code 99285 (ED physician visit, high complexity), 1 unit, billed $1,950.00, $1,540.00 above the EOB patient responsibility of $82.00. These are emergency services from an out-of-network provider, where the No Surprises Act limits the patient to in-network cost sharing.

  • Summit Imaging Group — 1 charge above the EOB, 1 charge billed by two providersSummit Imaging Group

    $332.35of $410.00 at risk

    • blockerSummit Imaging Group billed $410.00 for 2026-08-03, code 71046 (Chest x-ray, 2 views), 1 unit, billed $410.00, $391.00 more than the EOB patient responsibility of $19.00 for an in-network service.
    • warningcode 71046 (Chest x-ray, 2 views) on 2026-08-03 was billed by both St. Mary's Regional Medical Center and Summit Imaging Group, each for $410.00; Summit Imaging Group's line asks you for $410.00.

  • Clearview Outpatient Surgery Center — 1 Good Faith Estimate overageClearview Outpatient Surgery Center · respond by 2027-01-28

    $322.50of $430.00 at risk

    • blockerClearview Outpatient Surgery Center gave a Good Faith Estimate of $2,500.00 and billed $2,930.00, $430.00 more (the dispute threshold is $400). A dispute can be filed within 120 days of the bill dated 2026-09-30, by 2027-01-28.

The letter drafted for the largest case

Subject: Itemized bill review and correction request — St. Mary's Regional Medical Center, account HB-20931 (Sample Company Inc.)

Dear St. Mary's Regional Medical Center Billing Office,

I am writing about my account HB-20931 with St. Mary's Regional Medical Center. I compared the itemized bill with my insurer's Explanation of Benefits (EOB) and found the items below, which I believe need correcting. I may have misread something, so please check them against your records.

  - Amount billed above the patient responsibility on the EOB (account HB-20931): 2026-08-04, code 36415, Venipuncture: the statement shows $180.00 due from me; the EOB patient responsibility is $7.20. Difference: $172.80.
  - Amount billed above the patient responsibility on the EOB (account HB-20931): 2026-08-03, code 74177, CT abdomen and pelvis with contrast: the statement shows $2,576.00 due from me; the EOB patient responsibility is $156.00. Difference: $2,420.00.
  - Amount billed above the patient responsibility on the EOB (account HB-20931): 2026-08-07, code 80053, Comprehensive metabolic panel: the statement shows $96.00 due from me; the EOB patient responsibility is $4.80. Difference: $91.20.
  - Payment not shown as credited (account HB-20931): 2026-08-03, code 99223, Initial hospital care, high: I paid $250.00, but the balance still shows $250.00. Amount not credited: $250.00.
  - Line item that appears more than once (account HB-20931): 2026-08-03, code 85025, CBC with differential, 1 unit(s): this line appears more than once on the bill. Repeat charge: $3.68.
  - Unusual number of units (account HB-20931): 2026-08-04, code 36415, Venipuncture: 6 units were billed for one day; more than 3 is unusual for this code. Amount in question: $90.00.
  - Charge dated after discharge (account HB-20931): 2026-08-07, code 80053, Comprehensive metabolic panel: this charge is dated after the discharge date of 2026-08-05. Amount in question: $96.00.

What I am relying on:
  - For in-network services, the amount a patient owes is generally the patient responsibility shown on the plan's EOB (deductible, copay and coinsurance), under the provider's agreement with the plan.
  - I am asking for each charge to match the services actually provided, once, and for my payments to be credited to the account.

Total in question: $2,942.48 (some charges appear under more than one heading above; each is counted once in this total)

Could you please review the account, correct any errors, and send me an updated itemized statement? I would be grateful if the account could be placed on hold, and not referred to collections, while the review takes place. If you believe any item is correct as billed, please send the supporting detail (for example the medical record entry or the payment history).

Thank you for your help.

Kind regards,
Sample Company Inc.

Run the same check on your own export. Free for 14 days from your first import.

Download the sample fileStart free