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Open the companion tool →Why an EOB is a map of a claim, not an invoice
CMS's EOB guide distinguishes the provider's charge, the allowed charge, the plan payment, and the amount the plan says may be owed. A provider statement can arrive separately or before a claim is fully processed.
Putting the two documents side by side can show whether the mismatch is a different service date, a pending claim, a deductible, or a number that needs an explanation. It cannot establish which care is right or whether a charge is legally owed.
The protocol
- Keep the provider statement and the EOB for the same service dates; note which one is marked final or pending.
- Match the provider, service date, description, billed amount, allowed amount, plan payment, and patient-responsibility line.
- Write down the exact line that differs and ask the provider and plan to explain it using their official contact details.
- If the EOB shows a denial or reduced payment, follow the appeal instructions and deadline printed in the plan's notice; keep proof of submission.
- Do not ignore a bill while a question is open. Ask the provider whether billing can be paused while it checks the claim, and record the answer.
What the tool does
Build a medical EOB-to-provider-bill reconciliation record. It runs locally in this browser and sends nothing.
Limit first: This is a document-comparison aid, not medical, insurance, or legal advice. It cannot decide what care is appropriate, determine coverage, or make a provider or plan change a bill.
Open the companion tool →Cost and free path
Cost: Free: one complete local run in this browser, with no account or upload; the tool does not transmit what you enter. Optional $4 one-time convenience unlock for unlimited runs of this tool on this browser; never a subscription. The protective answer and every free-path step remain free.
Rule status (mixed route): Federal route, checked 2026-10-10: CMS's EOB guide separates provider charges, allowed charges, plan payment, and patient responsibility. Appeal routes and deadlines depend on the coverage and the written plan notice.
Automated decision this documents: automated health-plan claim adjudication that assigns an allowed amount, payment, or patient-responsibility figure
Free path, in order (no cost):
- The health plan's member-services and internal-appeal route (use the card or notice)
- The provider's billing office, reached through its official statement or website
- A state Consumer Assistance Program or insurance department, where available
What this cannot do: It cannot decide what care is appropriate, determine coverage, or make a provider or plan change a bill.
Sources checked 2026-10-10 · first-party source pages fetched and reviewed; no separate raw HTTP-status probe.
One human next step
Call the health plan using the number on your insurance card and ask for the claim's status, the reason for any difference, and the appeal route if a payment decision was made. CMS's appeal guide explains the general process; the plan notice controls your case's deadline.
Research log and safety checks
AI-assist path: not used for a legal, eligibility, authenticity, or payment verdict. This local builder organizes first-party records and routes the reader to a source they can inspect; no free model call would make its arithmetic or status claims more reliable. §6.9: no meaningful AI inference is needed. §6.11: the reader has a specific free action this week. §6.12: status route and date are in metadata. §6.13: the action does not require buying a service.
§0.5 protection result: category is insurance-and-medical-costs; crisis-adjacent: no; fear/urgency/scarcity toolkit used: no. The protective function is free and the paid feature is convenience only.