Explanation of benefits · the single most-called-about document
This is not a bill
Grade 19.75.2
Before
This document constitutes an explanation of benefits and does not represent a request for payment. The amounts reflected herein represent the provider's submitted charges, the contractual adjustment applied pursuant to the network agreement, the portion adjudicated as the plan's liability, and the residual amount which may be the responsibility of the member subject to applicable deductible and coinsurance provisions.
- Grade level
- 19.7
- Post-graduate
- Words
- 59
- Words / sentence
- 29.5
- Long words
- 34%
After
This is not a bill. It is a summary of a claim we already processed for you. It shows four things: what your doctor charged, the discount your plan got, the part we paid, and the part you may still owe. Your doctor's office will send you a separate bill for that last amount. If the two documents do not match, call the number on the back of your card before you pay anything.
- Grade level
- 5.2
- Grade 6 or below
- Words
- 74
- Words / sentence
- 14.8
- Long words
- 8%
What changed and why
- Moved the one sentence members need to the front: this is not a bill
- Turned four abstract nouns into four things the reader can point at
- Added the missing step — the real bill comes later, from someone else
- Told them what to do when the numbers disagree, which is when they call
Grade level is Flesch–Kincaid, computed from the text above. The formula counts sentence length and syllables, so short sentences score low — a 3.0 is not three times better than a 9.0. The target for member-facing material is usually sixth to eighth grade; the judgment about whether a rewrite is still accurate and complete is editorial, not arithmetic.