Medical Bill Calculator
Audit and verify medical bills by calculating allowed amounts, insurance write-offs, copayment credits, and prompt-pay settlement discounts.
Calculation Summary
Medical Bill Reconciliation Formula
Remaining Patient Balance = (Gross Billed - Insurance Network Discount - Insurance Payment - Copays Paid) × (1 - Prompt Pay Discount %)- Gross Billed Amount: The provider’s initial chargemaster list price.
- Insurance Network Discount: Contractual PPO/HMO adjustment write-off.
- Insurance Payment: Cash disbursed by the carrier directly to the facility.
- Prompt Pay Discount: Optional settlement percentage for immediate cash payoff.
Step-by-Step Worked Example
Calculation Steps:
- Contractual Allowed Amount = $4,200 - $1,800 = $2,400.
- Remaining Balance Before Discount = $2,400 - $1,600 - $50 = $750.
- Prompt Pay Savings = $750 × 15% = $112.50.
- Net Payoff Amount = $750 - $112.50 = $637.50.
How to Use This Calculator
- 1Enter the gross charges listed on your hospital statement.
- 2Input the insurance adjustment discount and carrier payment from your EOB.
- 3Enter any copayments or deposits already paid at the time of check-in.
- 4Apply a prompt-pay discount if you are paying the remaining balance in full.
Assumptions & Limitations
- Billing codes must be matched to your Explanation of Benefits (EOB) before paying.
- Prompt-pay discounts are voluntary and must be confirmed with the provider billing office.
Frequently Asked Questions
What is an Explanation of Benefits (EOB)?
An EOB is a document sent by your health insurer explaining what medical treatments were billed, what contractual discount was applied, what insurance paid, and what you owe.
Can I request an itemized hospital bill?
Yes. You have the legal right to request a detailed itemized bill with standard CPT and revenue codes to check for duplicate charges or unperformed tests.
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