It usually starts with a printout. An employee comes to HR with a hospital bill, an EOB that doesn't match it, and a question you weren't trained for: is this right, and do I have to pay it?
You can't work the bill for them, and you shouldn't try. But you can do more than hand them the number on the back of their insurance card. This is the short version of what actually helps.
Quick answer
The first conversation
Most employees in this spot are embarrassed and a bit panicked. They aren't alone. In KFF's health care debt survey, 41% of US adults said they were carrying debt from medical or dental bills, and 44% of those said they had held off paying a bill because they weren't sure it was accurate.
That second number is the useful one. A lot of these bills are worth questioning, and the employee needs to hear that asking is normal. In a 2023 national survey published in JAMA Health Forum, of the people who contacted the billing office about a bill they disputed or couldn't afford, about a quarter had the bill corrected and around one in seven got the price reduced.
Five things HR can do today
- Explain the EOB isn't a bill. The explanation of benefits shows what the plan paid and what the employee may owe. The provider's bill should match the "you may owe" amount. If it doesn't, that difference is the first question to ask the provider.
- Point them to the plan, not to you. Give them the member services or claims administrator contact for their plan. If the plan is self-funded, the claims administrator handles claims and appeals for it. HR's job is to connect, not to decide.
- Tell them about appeal rights. If a claim was denied, employer plans have to allow at least 180 days to file an internal appeal, and the denial notice says how. Plenty of people pay a denied claim because nobody told them they could appeal.
- Tell them to ask for financial assistance. Every nonprofit hospital must have a written financial assistance policy. Some cover balances left after insurance, not just uninsured patients. They can also ask for an itemized bill, which they have a right to under HIPAA.
- Offer the EAP, for the right part. If the bill has turned into a wider money problem, the EAP's financial counseling can help them plan. It usually won't work the bill itself. Our comparison of EAPs, navigation and bill advocacy explains why.
If the bill is from a nonprofit hospital and collections letters have started, there is usually still time. Federal rules say the hospital can't take extraordinary collection actions for at least 120 days after the first bill, and has to accept financial assistance applications for 240 days. The employee should ask for the policy and request a hold on the account while they apply.
What to stay out of
Wanting to help is the right instinct. A few things make it harder for everyone:
- Collecting the paperwork. Under HIPAA, a group health plan can give the employer summary health information and enrollment information. Anything more needs plan document changes and a certification. If an employee chooses to show you a bill, look, help, and don't keep a copy in their file.
- Calling the provider for them. The provider needs the patient's authorization to discuss the account, and you become the person they come back to every time a new letter arrives.
- Promising an outcome. "The plan should cover that" is easy to say and hard to take back. Stick to where they can get an answer.
Rules on employee health information go beyond HIPAA, so check anything that becomes a pattern with your benefits counsel.
What to say
Something like this covers it in a minute:
"Thanks for bringing this to me. I can't look into the bill itself, but here's who can. First, compare it with the EOB from the plan, and if the amounts don't match, ask the provider why. If the claim was denied, you have at least 180 days to appeal, and the letter tells you how. If it's a hospital bill, ask them for their financial assistance policy before you pay anything. And if this is putting pressure on your finances, the EAP has free financial counseling."
When it keeps happening
If this is the third bill this quarter, it isn't a one off. Deductibles have climbed, and the bills employees hold themselves have grown with them. That is the layer our piece on the bills employees pay looks at.
At that point some employers add a medical bill advocacy benefit, so there is a place to send people that actually works the bill: it checks the charges, applies for financial assistance, handles appeals and talks to the provider, while HR gets aggregate reporting and never sees the bill. mediloop is one of those services, so weigh that, and use our vendor checklist whoever you talk to.
Sources
- KFF Health Care Debt Survey
41% of US adults reported currently carrying health care debt, and 44% of those with debt said they had not paid because they were not sure the bill was accurate. Nationally representative survey of 2,375 adults, fielded February to March 2022.
- Duffy, Frasco and Trish, JAMA Health Forum, August 2024
Of adults who received a bill they disputed or could not afford, 61.5% contacted the billing office; among those, 25.7% had the bill corrected, 15.2% got a price reduction and 8.1% got financial assistance. Nationally representative survey of 1,135 adults, 2023.
- CMS, How to read an explanation of benefits
An explanation of benefits shows the total charges for a visit and is explicitly not a bill; it shows what the plan covered and what you will owe when the provider invoices you.
- US Department of Labor, Filing a claim for your health benefits
ERISA sets claim-processing timelines for employer plans, gives participants at least 180 days to appeal a denial, and notes the external review route depends on whether the plan is self-funded or insured.
- IRS, Financial assistance policy, section 501(r)(4)
Charitable hospitals must have a written financial assistance policy and an emergency medical care policy, and must publicise them widely.
- IRS, Billing and collections, section 501(r)(6)
Before any extraordinary collection action a hospital must make reasonable efforts to determine financial assistance eligibility: no collection for at least 120 days after the first billing statement, 30 days' written notice, and a 240-day application window.
- HHS Office for Civil Rights, Your medical records
HIPAA gives you the right to inspect and receive a copy of your medical and billing records, and a provider may not withhold copies over an unpaid bill or charge search and retrieval fees.
- eCFR, 45 CFR 164.504(f), group health plan disclosures to the plan sponsor
A group health plan may give the plan sponsor summary health information (for premium bids or amending the plan) and enrollment information. Disclosing other protected health information requires plan documents that restrict the sponsor's use and a certification from the sponsor.
Sources last checked 3 November 2026. Medical billing rules change, so if you spot something out of date, tell us and we will correct it.
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