My EOB shows I owe money — what does it mean?
Several reasons you might owe — and some are appealable.
Patient-owed amounts on EOBs come from: (1) Deductible — you haven't met your annual deductible yet; (2) Coinsurance — your % share after deductible; (3) Copay — fixed dollar amount; (4) Non-covered service — the plan won't pay; (5) Out-of-network reduction. Categories 1-3 are your normal cost-sharing. Categories 4-5 are commonly appealable.
Frequently asked questions
Why is my deductible showing on EVERY visit?
Your deductible resets every plan year (typically January 1 or your plan's effective month). Until you hit the deductible amount, you pay the full allowed amount for services. Once met, the plan starts paying its share.
I thought my plan covered this — why am I paying?
Check the CARC code. If it's a coverage decision (CARC 50 medical necessity, CARC 96 not covered, CARC 204 benefit exclusion), it's appealable. If it's normal cost-sharing (deductible, coinsurance, copay), it's not.
Can I appeal a deductible?
Generally no — deductible is your benefit design. BUT if the service should have been a preventive service at $0 cost-sharing under ACA §2713, that IS appealable.
More EOB guides
- EOB vs bill — what's the difference?Don't confuse them. EOB is informational; bill is what you actually pay.
- How to read your Explanation of Benefits (EOB)Your EOB is the statement your plan sends after processing a claim. Here's what
- Secondary insurance EOB — what does it mean?When you have two plans, both send EOBs. Read them in the right order.
- There's a denial on my EOB — what do I do?Diagnose the CARC code, then either appeal or accept based on whether the code i
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