Not medically necessary
The insurer says the service was not required. Ask what evidence or provider records would support review.
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 will 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 listed charge.
- Allowed amount - the amount your insurer recognized for the claim.
- Plan paid - what your insurer paid the provider.
- Patient responsibility - the amount the EOB says may be your share after deductible, coinsurance, or copay.
- Reason codes - short codes such as CO-50 or PR-204 that explain 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 says it does not cover this service. Ask the insurer for the denial reason, appeal route, and deadline from your plan documents.
FAQ
Common questions.
What's the difference between an EOB and a bill?
The EOB is from your insurance company. It explains how the claim was processed. The bill is from your provider. It is the payment request. Compare the two before paying.
Do I have to pay what the EOB says?
Use the EOB as a comparison point. If the provider bill asks for more than the EOB patient responsibility, ask the provider and insurer to reconcile the claim before paying.
I don't see a reason code on my EOB. Where is it?
Reason codes (also called CARC codes) appear next to each line item, often abbreviated like 'CO-50' or 'PR-1'. If they're missing, request a fully itemized EOB from your insurer's member services.
What if my EOB shows a denial?
Check the denial notice or plan documents for the appeal deadline and submission route. The Appeal Generator can help draft a focused internal appeal from the denial reason and evidence you provide.
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?