What is an Explanation of Benefits (EOB)?

An Explanation of Benefits (EOB) is a statement from your health insurance company explaining what portion of a medical claim was paid, what was denied, and what you owe. It is not a bill — it is a summary of how your insurer processed a claim.

How do I appeal a denied insurance claim?

To appeal a denied health insurance claim: (1) Request your insurer's written denial with the specific denial code and reason, (2) Gather supporting documentation from your doctor, (3) Write a formal appeal letter citing the denial code, your policy terms, and clinical evidence, (4) Submit within your plan's appeal deadline (typically 30–180 days). ClaimSage can generate a customized appeal letter for your state and denial type for free.

What does my health insurance actually cover?

What your health insurance covers depends on your specific plan. Key factors include your deductible (amount you pay before insurance kicks in), copay (fixed amount per visit), coinsurance (percentage you pay after deductible), and out-of-pocket maximum. ClaimSage's Benefits Navigator lets you describe your situation and instantly find out what your plan likely covers.

How much will my medical procedure cost with insurance?

Your out-of-pocket cost for a medical procedure depends on whether you've met your deductible, your plan's coinsurance rate, your copay, and whether the provider is in-network. ClaimSage's Cost Estimator calculates your estimated out-of-pocket cost based on your specific plan details and procedure.

AI-powered QSEHRA & benefits explainer — for small employers

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78% of administrative denials are overturned on appeal (Source: CMS/KFF Marketplace Claims Data)

78%

of administrative claim denials are overturned on appeal — AI-powered explainer for EOBs, denials, and QSEHRA

Source: CMS / KFF Marketplace Claims Data

$6,150

max 2024 QSEHRA reimbursement per employee — 100% tax-free for both employer and employee

Source: IRS Notice 2023-74 / KFF Employer Health Benefits Survey

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Your data stays private We don't store uploaded documents. EOBs are processed in memory only and never saved to our servers. Learn how your data is handled →

Health insurance is designed to confuse you

Every year, millions of Americans overpay, miss covered benefits, or accept denied claims they could have won. The system works because most people don't understand their own policies. ClaimSage changes that.

51%

of denied claims are never appealed, even though over half of appeals succeed

$1,000+

average surprise medical bill from out-of-network charges people didn't know to check

80%

of EOBs contain errors that go unnoticed by policyholders

How it works

Three steps to taking control of your coverage

Upload your EOB or describe your situation

Snap a photo of your Explanation of Benefits, paste the text, or just describe what happened. ClaimSage reads and understands it in seconds.

AI analyzes against state regulations and insurer patterns

ClaimSage cross-references your claim against your state's insurance statutes, your insurer's known denial patterns, and CMS benchmark data.

Get a personalized appeal letter, cost breakdown, or benefits summary

Download a ready-to-send appeal letter citing your state's specific regulations, or get a plain-English explanation of exactly what you owe and why.

Free tools

Four ways ClaimSage fights for you

Each tool is free to use. No signup, no credit card.

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EOB Reader

Paste or photograph your Explanation of Benefits and get a plain-English breakdown: what was covered, what was denied, why, and exactly what you owe — in under 30 seconds.

✓ Catches billing errors most patients miss

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Appeal Letter Generator

Get a ready-to-send appeal letter citing your state's insurance statutes and your insurer's own coverage rules. Covers all 50 states with state-specific regulatory citations.

✓ 78% of admin denials overturned on appeal

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Benefits Navigator

Describe your insurance plan and get a clear breakdown of what's covered, what requires prior authorization, and the hidden gotchas your insurer buries in the fine print.

✓ Uncovers benefits you didn't know you had

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Cost Estimator

Enter your procedure, insurance type, and location to see your estimated out-of-pocket cost before you book. Includes fair-price benchmarks and in-network vs. out-of-network comparison.

✓ Avoid surprise bills before they happen

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Eligibility Screener

Answer 8 quick questions and find out if you qualify for free or low-cost health coverage — Medicaid, CHIP, Medicare, ACA subsidies, and hospital financial assistance.

✓ Check 5 programs in 2 minutes

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Small Employer Guide

Compare SHOP Marketplace, QSEHRA, and ICHRA for teams under 25. Understand tax credits up to 50%, reimbursement limits, and enrollment — without a broker.

✓ Free coverage assessment included

Health insurance shouldn't require a law degree to understand

For small employers, that means a simple way to offer real benefits without a broker or a group plan. For individuals, that means a fair shot at the coverage you already paid for.

Calculate Your QSEHRA Savings

Or try the free tools: EOB Reader & Appeal Generator

Not Legal, Medical, or Insurance Advice. ClaimSage provides AI-powered health insurance education and tools. ClaimSage is not a law firm, insurance company, or licensed advisor. Information provided is for educational purposes only and does not constitute legal, medical, or insurance advice. Always consult a licensed professional for guidance specific to your situation.