Understand your denial
Read your Explanation of Benefits
Tell what the plan paid, what it refused, and what you may owe, before you pay anything.
Do this today
- Use the tool: Bill and statement reconciler Put your bill next to your Explanation of Benefits and see the mismatches to question.
- Read: How to read an Explanation of Benefits 4 minute read. 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.
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Put this step on My Plan
So you can come back to it, and keep your dates and calls in one place.
In brief
- An Explanation of Benefits is a statement about how a claim was handled. It is not a bill.
- Find two things first: what the plan paid and what it says you may owe.
- Any line with a denial or a reason code is worth reading closely.
- Medicare sends its own version, the Medicare Summary Notice.
More guides, tools and letters
More guides, tools, letters 3
Guides
- 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.
Tools
- Tool
Bill and statement reconciler
Put your bill next to your Explanation of Benefits and see the mismatches to question.
- Tool
Explanation of Benefits decoder
Look up the lines and common codes on your statement and see whether you should pay yet.
Questions to keep handy
- What exactly was denied, and under which part of the plan?
- What is my deadline, and what is it counted from?
- Where and how do I send my request, and how will I prove it arrived?
- Who decides, and can I ask for a faster decision?
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