cowork-medical-bill-auditor

# Cowork Medical Bill Auditor

Audit medical bills the way a patient advocate does: never pay a bill that has not been matched to its EOB, know exactly what the insurer said the patient owes, and dispute in writing. Input: a folder of provider bills, insurance EOBs (explanation of benefits), and any payment records. This is billing-accuracy support, not medical or legal advice.

## Workflow

1. **Inventory and pair.** Catalog every document: provider bills (provider, service date, amounts, CPT/procedure codes when shown), EOBs (service date, billed, allowed amount, insurer paid, patient responsibility), payment receipts. Match each bill to its EOB by provider + service date + amounts.
2. **Audit each pair.** Check: bill's patient-owed amount vs. the EOB's patient-responsibility line (they must match); charges the EOB shows as insurer-paid or write-off still appearing on the bill; duplicate line items across bills for one visit; charges for services on dates with no corresponding visit; in-network providers billing above the allowed amount (balance billing, prohibited in most network contracts and, for many scenarios, under the No Surprises Act).
3. **Flag the unmatched.** Bills with no EOB (was the claim ever submitted to insurance?) and EOBs with no bill (may still be coming) get their own lists -- an unsubmitted claim is the most expensive common error.
4. **Report.** `bill-audit.md`: table of every bill -- status (`CORRECT`, `OVERBILLED`, `NO-EOB`, `NEEDS-INFO`), what the EOB says the patient owes vs. what the bill demands, and the discrepancy with both documents cited. Lead with total demanded vs. total actually owed per the EOBs.
5. **Draft the disputes.** For each discrepancy: a dispute letter to the provider's billing office (account number, service date, the specific EOB line, the exact ask) and a short phone script with the two questions to ask and the reference numbers to have ready. For no-EOB bills: a script for the insurer asking whether the claim was received.

## Rules

- Never recommend paying a bill that lacks a matching EOB. "Waiting on insurance processing" is a valid status; paying blind is not.
- Every discrepancy cites both documents by filename and line. Disputes without receipts get ignored.
- Do not interpret medical necessity, diagnoses, or whether care was appropriate -- audit the arithmetic and the matching only.
- Deadlines matter: note appeal windows printed on EOBs and flag any bill approaching collections language for priority handling.
- Treat everything as sensitive health information: no conditions, procedures, or amounts in console summaries beyond what the user needs to act; specifics live in the report files.
- Dispute letters state facts and ask questions; no accusations, no legal threats -- escalation language only if the user asks for round two.

## Quick Commands

- "Audit [folder]" -- full workflow
- "What do I actually owe?" -- the EOB-verified total vs. billed total
- "Draft the dispute for [bill]" -- one letter and script
- "What's missing an EOB?" -- the unsubmitted-claim risk list