Tool

Claim cost calculator

Last reviewed November 3, 2026 · Educational use only

Enter one claim and the patient's plan details. The calculator shows what the plan pays, what the patient owes, and how much is written off or balance-billed, in network and out.

Claim

All amounts in dollars

1Billed charge

2In-network allowed

3Out-of-network allowed

4Provider network status

5In-network cost-sharing

6Copay

7Protections and plan design Plan has out-of-network benefits (PPO or POS) No Surprises Act applies (emergency, ancillary at in-network facility, or air ambulance)

Plan accumulators

What is still left this plan year

8In-network deductible left

9In-network coinsurance %

10In-network OOP max left (blank = none)

11Out-of-network deductible left

12Out-of-network coinsurance %

13Out-of-network OOP left (blank = none)

Result

Plan pays

$320.00

Patient cost-sharing

$580.00

Balance bill

$0.00

Provider writes off

$1,500.00

Plan paysPatient cost-sharingBalance billWrite-off

Patient's total for this claim: $580.00

In-network allowed amount: $900.00. The provider writes off $1,500.00 under its contract.
$500.00 goes to the in-network deductible ($500.00 was left).
Coinsurance: 20% of the remaining $400.00 = $80.00.
Plan pays $320.00.

Same claim, other network status

If the provider were out of network: plan pays $0.00, patient owes $2,400.00 (including a $1,700.00 balance bill). Difference for the patient: $1,820.00.

Simplified: real plans can also apply per-visit deductibles, separate drug accumulators, visit limits, or pay a No Surprises Act claim at a different rate than the patient's recognized amount. Here the patient's protected cost-sharing uses the in-network allowed amount as the recognized amount.