Can AI explain my insurance EOB?
Yes. It explains what was billed, what insurance allowed and paid, and what you owe, and flags anything that doesn't match your bill.
01Why bot
- EOB terms are standard and easy to explain.
- Comparing it with your bill catches mistakes.
- It reminds you that an EOB is not a bill.
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Book this spot →02The prompt
Replace everything in [BRACKETS] with your own details, then paste it into your AI app.
You are a health insurance educator. My EOB lines (remove member ID): [EOB] The provider's bill, if I have it: [BILL] Your task: explain it. Rules: - MUST explain billed, allowed, paid and patient responsibility in plain English. - MUST check the math on each line. - MUST flag any difference between what I owe on the EOB and on the bill. Give me: a plain summary, a line table, and questions to ask.
03Steps
- Match the EOB to the bill by date of service.
- Run the prompt.
- Call about any mismatch before paying.
04What can go wrong
- Remove ID numbers before pasting.
- An EOB is not a bill; wait for the provider's bill.
05What to use
Any major AI chat app.
06Our test runs
2 runs, each with a different made-up sample. 1 of 2 passed every check.
Run 1 · Llama 3.3 70B · graded by GPT-OSS 120BOct 11, 2026Passed with a catch
The made-up sample:
[EOB]EOB for John Doe, DOB 01/01/1980, Claim #123456789, Service Date 09/01/2026. Provider: ABC Family Medicine. CPT 99213 Office Visit: Billed $150.00, Allowed $120.00, Contractual Adjustment $30.00, Paid $96.00 (80% of allowed), Patient Responsibility $24.00 (copay $20 + $4 deductible). CPT 81002 Urine drug screen: Billed $45.00, Allowed $30.00, Contractual Adjustment $15.00, Paid $24.00 (80% of allowed), Patient Responsibility $6.00. Total Billed $195.00, Total Allowed $150.00, Total Paid $120.00, Total Patient Owes $30.00. Note: Deductible met $50 of $200 annual deductible.[BILL]Provider Bill for ABC Family Medicine, Patient John Doe, DOB 01/01/1980, Account #987654321. Date of Service: 09/01/2026. CPT 99213 Office Visit $150.00. CPT 81002 Urine drug screen $45.00. Total Charges $195.00. Balance Due $195.00.
- Explain billed, allowed, paid, patient responsibility in plain English
- Check the math on each line
- Flag any difference between what I owe on the EOB and on the bill
- Provide plain summary, line table, and questions to ask
- Made up details we never gave it
Details it made up: “$10 towards your deductible”, “assuming the $4 deductible is part of the $10”
What came back (excerpt):
You visited ABC Family Medicine on September 1, 2026, and had an office visit (CPT 99213) and a urine drug screen (CPT 81002). The provider billed $195.00 for these services.
Read the full answer
**Plain Summary:** You visited ABC Family Medicine on September 1, 2026, and had an office visit (CPT 99213) and a urine drug screen (CPT 81002). The provider billed $195.00 for these services. Your insurance allowed $150.00 for these services and paid $120.00 (80% of the allowed amount). You are responsible for the remaining $30.00, which includes a $20 copay and $10 towards your deductible ($4 deductible was mentioned in the EOB, but $10 is the difference between the $20 copay and the $30 patient responsibility, assuming the $4 deductible is part of the $10). You have met $50 of your $200 annual deductible. **Line Table:** | Service | Billed | Allowed | Contractual Adjustment | Paid | Patient Responsibility | | --- | --- | --- | --- | --- | --- | | Office Visit (CPT 99213) | $150.00 | $120.00 | $30.00 | $96.00 | $24.00 | | Urine Drug Screen (CPT 81002) | $45.00 | $30.00 | $15.00 | $24.00 | $6.00 | | Total | $195.00 | $150.00 | $45.00 | $120.00 | $30.00 | **Math Check:** * Office Visit: $150.00 (billed) - $30.00 (contractual adjustment) = $120.00 (allowed), $120.00 (allowed) x 0.8 = $96.00 (paid), $120.00 (allowed) - $96.00 (paid) = $24.00 (patient responsibility) * Urine Drug Screen: $45.00 (billed) - $15.00 (contractual adjustment) = $30.00 (allowed), $30.00 (allowed) x 0.8 = $24.00 (paid), $30.00 (allowed) - $24.00 (paid) = $6.00 (patient responsibility) * Total: $195.00 (billed) - $45.00 (contractual adjustment) = $150.00 (allowed), $150.00 (allowed) x 0.8 = $120.00 (paid), $150.00 (allowed) - $120.00 (paid) = $30.00 (patient responsibility) **Difference between EOB and Bill:** The provider's bill shows a balance due of $195.00, but the EOB states that you owe $30.00. This is a significant difference. You should contact the provider to clarify why they are showing a different balance. **Questions to Ask:** 1. Why is the provider's bill showing a balance due of $195.00 when the EOB states that I owe $30.00? 2. Can the provider explain the contractual adjustment and how it affects my bill? 3. How much of my annual deductible has been met, and what is the remaining balance? 4. Can I get a detailed explanation of the $20 copay and the $4 deductible mentioned in the EOB? 5. What is the next step to resolve the difference between the EOB and the provider's bill?
Check that the answer includes plain English explanations and flags the bill/EOB discrepancy.
Run 2 · Llama 3.3 70B · graded by GPT-OSS 120BNov 7, 2026Passed
The made-up sample (a messier one):
[EOB]Member: Jane Doe Plan: ABC Health PPO Date of Service: 03/12/2024 Provider: Dr. Sam Patel, Family Medicine Line 1: Office Visit – CPT 99213 Billed: $150.00 Allowed: $100.00 Insurance Paid: $80.00 Patient Responsibility: $20.00 (copay) Line 2: Blood Test – CPT 80050 (Comprehensive Metabolic Panel) Billed: $85.00 Allowed: $70.00 Insurance Paid: $56.00 Patient Responsibility: $14.00 (coinsurance 20%) Line 3: X‑ray, Right Knee – CPT 73560 Billed: $250.00 Allowed: $180.00 Insurance Paid: $144.00 Patient Responsibility: $36.00 (coinsurance 20%) Total Billed: $485.00 Total Allowed: $350.00 Total Insurance Paid: $280.00 Total Patient Responsibility: $70.00 Notes: Prior authorization was approved for X‑ray. Lab was marked as "routine" and processed under standard benefits. If you have questions, call 1‑800‑555‑1234 (ext. 2).[BILL]Dr. Sam Patel, MD Family Medicine Clinic 123 Main St., Anytown, USA Phone: (555) 987‑6543 Invoice Date: 03/20/2024 Patient: Jane Doe Account #: 789456 1. Office Visit (99213)..............$150.00 2. Comprehensive Metabolic Panel (80050)..............$85.00 3. Knee X‑ray – Right (73560)..............$250.00 Subtotal: $485.00 Insurance Adjustments: $350.00 (see EOB) Amount Due: $135.00 Due by: 04/19/2024 Please make checks payable to "Family Medicine Clinic" or pay online at www.fammedclinic.com/pay. If you have insurance, submit this bill with your EOB. Thank you for choosing our practice!
- Explain billed, allowed, paid, patient responsibility in plain English
- Check the math on each line
- Flag any difference between EOB and bill amounts
- Provide plain summary, line table, and questions to ask
- Didn't make up details we never gave it
What came back (excerpt):
You visited Dr. Sam Patel on March 12, 2024, and had an office visit, a blood test, and an X-ray. The doctor's office billed your insurance company, ABC Health PPO, for these services.
Read the full answer
**Plain Summary:** You visited Dr. Sam Patel on March 12, 2024, and had an office visit, a blood test, and an X-ray. The doctor's office billed your insurance company, ABC Health PPO, for these services. Your insurance company reviewed the bills and determined how much they would pay for each service. You are responsible for paying the remaining amount. Here's how it works: * **Billed:** This is the amount the doctor's office charged for each service. * **Allowed:** This is the amount your insurance company has agreed to pay for each service. It's usually lower than the billed amount. * **Insurance Paid:** This is the amount your insurance company actually paid for each service. * **Patient Responsibility:** This is the amount you need to pay for each service. It can be a copay (a fixed amount) or coinsurance (a percentage of the allowed amount). **Line Table:** | Service | Billed | Allowed | Insurance Paid | Patient Responsibility | | --- | --- | --- | --- | --- | | Office Visit | $150.00 | $100.00 | $80.00 | $20.00 (copay) | | Blood Test | $85.00 | $70.00 | $56.00 | $14.00 (20% coinsurance) | | X-ray | $250.00 | $180.00 | $144.00 | $36.00 (20% coinsurance) | Let's check the math on each line: * Office Visit: $100.00 (allowed) - $80.00 (insurance paid) = $20.00 (patient responsibility) - correct! * Blood Test: $70.00 (allowed) - $56.00 (insurance paid) = $14.00 (patient responsibility) - correct! * X-ray: $180.00 (allowed) - $144.00 (insurance paid) = $36.00 (patient responsibility) - correct! **Difference between EOB and bill:** The EOB says your total patient responsibility is $70.00, but the bill from the doctor's office says you owe $135.00. This is a significant difference! You should contact the doctor's office and your insurance company to clarify why there is a discrepancy. **Questions to ask:** 1. Why is there a difference between the amount I owe on the EOB ($70.00) and the amount I owe on the bill ($135.00)? 2. Can you explain why the insurance company only paid $280.00 out of the $350.00 allowed amount? 3. How did the insurance company determine the allowed amount for each service? 4. Can I get a detailed breakdown of the insurance adjustments made on the bill? 5. What happens if I don't pay the bill by the due date (April 19, 2024)?
Check that all required sections (summary, table, questions) are present.
How each run works: we fill the prompt with a made-up sample, run it once in Llama 3.3 70B, and GPT-OSS 120B grades the answer against the prompt's own rules. Word limits are counted by code, and every quote flagged as made up is checked against the full answer. Your results can differ. How we test.
Prompt packMedical Bills & Insurance 10 step-by-step prompts that go further than this one, $15.
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