Not medically necessary
Insurer says the service wasn't required. Often appealable with provider documentation. Use the Appeal Generator.
Free EOB Scan
Free EOB scanner. Decode the document insurance won't translate.
An Explanation of Benefits is your insurer's record of how a claim was processed. Upload it and we'll translate the key fields in plain English.
What an EOB actually says
Six fields. One comparison checklist.
An EOB has six fields that help decide what to check on the provider bill. Most patients glance at the dollar figure and miss the rest:
- Billed amount — the provider's chargemaster price (sticker).
- Allowed amount — the negotiated rate your insurer will recognize. This is the meaningful number for in-network care.
- Plan paid — what your insurer actually paid the provider.
- Patient responsibility — the amount the EOB says may be your share after deductible / coinsurance / copay.
- Reason codes — short codes (CO-50, PR-204, etc.) that explain any denials or adjustments.
- Date of service — should match the bill lines you are comparing.
The free EOB scanner reads the fields we can extract, decodes common reason-code language in plain English, and tells you what to compare against the provider bill before paying.
What we decode
Common EOB reason codes.
Bundled service
The insurer says the service is included in another processed service. Compare the provider bill before paying a separate line.
Charge exceeds fee schedule
The billed charge is above the amount the insurer recognized. Check whether the provider adjusted the bill to match the EOB.
Deductible
Applied to your deductible. Legitimate, but verify the year-to-date total.
Coinsurance
Your share after deductible. Verify the percentage matches your plan.
Not covered by plan
Your plan doesn't cover this service. Often appealable, especially for medical necessity.
FAQ
Common questions.
What is the difference between an EOB and a medical bill?
The difference between an EOB and a medical bill is the sender: the EOB comes from your insurance company, the bill comes from your provider. Up to 49% of medical bills contain at least one error (CFPB, 2023), and the audit happens by comparing the two documents — provider name, date of service, claim number, allowed amount, and patient responsibility should match. Pay the lower of the two only after the claim is final.
Do I have to pay what the EOB says I owe?
You do not have to pay what the EOB says you owe before you verify the claim is final and the provider bill matches the EOB's patient-responsibility line. About 73.7% of patients who actually dispute a medical bill receive a correction (JAMA Health Forum, 2024). The EOB is a strong comparison point, not a bill — verify the dates, the claim status, and the provider statement agree before sending payment.
I don't see a reason code on my EOB — where is it?
EOB reason codes (also called CARC codes) appear next to each line item, abbreviated like CO-50, PR-1, or PR-204. If reason codes are missing, request a fully itemized EOB from your insurer's member services. Up to 49% of medical bills contain at least one error (CFPB, 2023), and the CARC code is what tells you whether a charge is denial-based, deductible-based, or balance-bill — without it, the EOB is much harder to audit.
What if my EOB shows a claim denial?
If your EOB shows a claim denial, your appeal window depends on the plan type and the denial notice — internal appeals are usually 180 days, external review another 60-120. About 73.7% of patients who actually dispute a medical bill receive a correction (JAMA Health Forum, 2024), and denials are the highest-leverage place to fight because the insurer is bound by ERISA or state rules. Use the BillBusted Appeal Generator to draft a letter around your specific denial reason.
Have a bill in front of you right now?
The free scan answers one question in 60 seconds: does this bill deserve a closer look?