Explanation of Benefits decoder

Look up the lines and common codes on your statement and see whether you should pay yet.

Private: nothing leaves this tab
General information, not legal advice

What it asks, and what it is not

What it asks. The wording on your statement, whether a denied line mentions the network, whether you have a bill, and whether the amounts match.

Everything you type stays in this browser tab. Nothing is sent anywhere, and no account is needed.

What it is not. It explains common wording. Your statement's own key of codes is the final word on what a code means for your claim.

Answer the questions

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This tool needs JavaScript to calculate. Here is a version that works without it. You can print this page and fill it in by hand.

Questions to answer on paper

Tick one answer for each question (more than one where it says so). Some questions only apply after certain earlier answers. "Not sure" is always a fine answer.

What does the statement say about the claim?

Pick the wording closest to the line you are worried about. If a statement has several, start with the biggest amount.
- Denied or not covered
- Paid less than the amount billed
- Applied to my deductible
- Patient responsibility, with "this is not a bill"
- No payment because more information is needed
- Processed as out-of-network
- Not sure what it says
Does the reason next to the denied line mention out of network or network?

Look for wording such as out of network, non-participating provider or no network benefit. The statement's key of codes explains each code.
- Yes, it mentions the network
- No, it gives another reason
- Not sure, or there is no reason shown
Has the provider sent you a bill yet?

A bill asks you to pay an amount by a date. A statement from your plan usually says it is not a bill.
- Yes, I have a bill
- No, I only have the statement
- Not sure whether what I have is a bill
Does the amount on the bill match the patient responsibility on the statement?
- Yes, the amounts match
- No, the bill is higher
- No, the bill is different in another way
- Not sure how to compare them

Then read the guide: Read your Explanation of Benefits, which lays out the steps for each case.

Private: nothing leaves this tab
General information, not legal advice

What it asks, and what it is not

What it asks. The wording on your statement, whether a denied line mentions the network, whether you have a bill, and whether the amounts match.

Everything you type stays in this browser tab. Nothing is sent anywhere, and no account is needed.

What it is not. It explains common wording. Your statement's own key of codes is the final word on what a code means for your claim.

Related guides and checklists

Guide

How to read an Explanation of Benefits

What the lines on an Explanation of Benefits mean, how to tell what you owe from what was refused, and why you should not pay from it alone.

Part of Understand your denial · Read your Explanation of Benefits · My Plan

Answer the questions

Related guides and checklists

How to read an Explanation of Benefits