Paste anything from your medical bill, EOB, or denied claim — CPT codes, ICD codes, billing terms, denial codes — and get a plain-English explanation of each item.
EOB ≠ bill. If you pasted an Explanation of Benefits, do not pay it. An EOB is a summary from your insurance company — the actual bill comes separately from the provider.
Common Questions About Medical Bills
An Explanation of Benefits (EOB) is a document from your insurance company showing how a claim was processed. It shows billed amounts, what insurance paid, and what you owe — but it is not a bill. Wait for the separate bill from the provider (doctor, hospital, lab) before paying. Many people accidentally pay the EOB thinking it's a bill.
No. The contractual adjustment (also called provider write-off, network discount, or non-covered amount) is money the in-network provider agreed to forgo as part of their contract with your insurer. They cannot bill you for it. If your bill shows a $200 billed amount and a $120 contractual adjustment, the provider has already agreed that $120 is erased — you only owe whatever remains.
First, find the denial reason code (usually starts with CO- or PR-). The most common denial is CO-50 (not medically necessary) — call your insurer, ask your doctor for a letter of medical necessity, and file a formal appeal. Most insurers allow 180 days to appeal. If the denial is CO-18 (duplicate claim), check whether the claim was already paid. Always appeal in writing and keep records.
Providers set "chargemaster" prices (billed amounts) far above what they actually collect. In-network providers contract to accept a much lower "allowed amount." The difference is the contractual adjustment — it's not a discount, it's a contractual write-off. Cash-pay patients often face the full chargemaster price, which is why it's worth calling the billing department to negotiate or ask for the "self-pay rate."
Deductible: Fixed annual amount you pay before insurance covers anything (e.g., first $1,500/year). Copay: Fixed dollar amount per visit or service (e.g., $25 per office visit), regardless of the total cost. Coinsurance: Your percentage of covered costs after meeting your deductible (e.g., you pay 20%, insurance pays 80%). Your copay and coinsurance usually count toward your out-of-pocket maximum.
Yes — especially for large balances. Call the billing department and ask: (1) Are there any errors on this bill? (2) Do you offer financial assistance or charity care? (3) What is the self-pay or cash-pay rate? (4) Can we set up a payment plan? Hospitals are often required to offer charity care and rarely publicize it. A 20–40% reduction on an uninsured or out-of-network bill is common when you ask.
Prior authorization (PA) means your insurance company must approve a service before it happens or before they'll pay for it. If a service requiring PA was done without it, the claim may be denied. You can request retroactive authorization in some cases. Your doctor's office usually handles PA requests — contact them if you get a denial citing missing PA.
Not medical or legal advice. This tool explains what medical billing terms mean — it does not verify whether your bill is correct or advise on dispute strategies. If you believe a bill contains errors, contact the provider's billing department directly. For billing disputes, consider contacting your state insurance commissioner or a patient advocate.