Insurance Statement Decoder

Your Explanation of Benefits is not a bill, but it controls what you may owe. This tool breaks down each line: allowed amounts, patient responsibility, and adjustment codes so you know what happened on the claim.

What you get

Line-by-line plain-English explanations
Notes on whether your share looks typical or worth questioning
Context on deductibles, coinsurance, and denials on the same document
A record you can compare to the provider’s bill when it arrives

Who this is for

Anyone with a stack of EOBs after a hospital stay, surgery, or new plan year who wants to verify the math before paying.

Common situations this tool handles

You received three EOBs after a hospital stay and the math across all three does not add up to what you have been billed.
Your EOB shows a denial code PR-2 and you do not know whether that means you owe the money or the provider does.
Your insurance processed a claim at a lower allowed amount than what you were quoted at the time of service.

What your analysis looks like

Sample analysis for illustration. Your output will reflect your specific document and situation.

EOB REVIEW SUMMARY

Payer: [Insurance company] Member: [Member name] Date of service: [Date] Provider: [Provider name]

LINE-BY-LINE REVIEW

Line 1 -- CPT 99214 (Office Visit, Moderate Complexity)

Billed: $285.00 | Allowed: $142.50 | Plan paid: $114.00 | Your share: $28.50 Notes: The allowed amount reflects the contracted rate between your insurer and the provider. The difference between billed ($285) and allowed ($142.50) is a contractual adjustment -- you do not owe that difference. Your share of $28.50 represents your 20% coinsurance after the deductible was already met.

Line 2 -- CPT 85025 (Complete Blood Count)

Billed: $48.00 | Allowed: $22.00 | Plan paid: $0 | Your share: $22.00 Denial code: PR-1 (Deductible) Notes: This charge was applied to your deductible, not denied. PR-1 means patient responsibility due to deductible. If your deductible is not yet met, this is a legitimate charge. Verify your deductible accumulation on your plan's member portal.

Line 3 -- CPT 93000 (ECG)

Billed: $95.00 | Allowed: $0 | Plan paid: $0 | Your share: $0 Denial code: CO-97 (Bundled service) Notes: CO-97 means this service is considered bundled with another service billed on the same date. This is a provider billing issue, not your responsibility. You should not be billed for this line item. If you receive a bill from the provider for this charge, you can reference the CO-97 denial on your EOB.

[Full analysis with deductible tracking and next steps follows...]

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Questions about this tool

What is the difference between a denial and a patient responsibility adjustment?

Denial codes starting with CO mean the provider cannot bill you. Codes starting with PR mean the amount is your responsibility. Codes starting with OA are other adjustments. This distinction determines whether you owe the money.

My EOB says I owe more than the provider's bill. Which is correct?

Follow the provider's bill for payment purposes. EOBs sometimes show projected cost-sharing before the claim fully processes. If the difference is significant, call the provider's billing office and ask them to verify the final patient balance.

How long should I keep my EOBs?

Keep EOBs for at least one year to match against provider bills and resolve disputes. If the service relates to a tax deduction, ongoing condition, or legal matter, keep them longer.

How it works

Upload your document. Photo or PDF of your medical bill, EOB, denial letter, or COBRA notice. No account needed to start.
We review it. Bill Advantage reviews your document against healthcare billing rules, insurance regulations, and common error patterns, reflecting the knowledge of healthcare billing professionals, encoded into a system that works in minutes, not days.
You get answers. Receive a plain-English explanation of exactly what happened and why. For most tools, a ready-to-send dispute or appeal letter is included. Save results to your Healthcare Finance Tracker, set reminders for follow-up deadlines, and build a complete record of your healthcare finances over time.

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