Audit receipt: your benefits summary
Source: CMS sample Explanation of Benefits, Publication #11819, May 2022 · two visits on March 20, 2022 · language: EN
SIMPLE score
Scored 0 to 4 per dimension by the adversarial auditor. Passing floor: 3 on every dimension.
Original vs simplified
The original was a CMS teaching specimen: its sentences already read plainly, so Style started high. The gains are in Organization and Purpose: the answer moved out of an eleven-column table to the first screen.
Readability
Reading grade is Flesch-Kincaid for English, target 6 or below for health content. The word count rose (the terse table became explained prose), which is the right trade here: the reader gains the answer and the meaning of the numbers, both missing from the original.
What was done
- Led with the answer: your share is $35.00, and this is not a bill, moved to the first screen from inside the claim table.
- Made the defining caveat unmissable: this page names no payee and no due date, so the reader is told to wait for the provider's bill and not pay from this summary.
- Turned the eleven-column claim table into a three-figure summary (provider billed $406.60, plan paid $85.27, your share $35.00), with the full line-by-line detail kept behind an expander.
- Explained the confusing $406.60 to $120.27 drop in plain words, from the source remark code PDC, instead of leaving a three-letter code.
- Defined allowed price, copay, deductible, coinsurance, and PDC at the term; no glossary page.
- Kept the appeal right and the customer service number 1-800-123-4567 visible, with tap-to-call.
Upgrade pass, July 30, 2026. Four additions brought the page to the current standard:
- Spelled out the second visit's math in words and numbers: the allowed price ($118.12) minus your copay ($35.00) equals what your plan paid the doctor ($83.12).
- Added a refund note: if you already paid more than $35.00 at the office, the money back goes to the payee shown on your summary. On this sample the payee is blank, so your own summary names who gets it.
- Made the governing rule plain before the detail: your plan pays the lower allowed price it agreed with your provider, not the billed price, and your share is worked out from the allowed price.
- Stated the provenance: every amount shown is from the CMS sample, not a real member's statement, and your own summary controls.
Calculators: none, on purpose. This summary is a fixed two-visit sample with no figure the reader would enter, so its one arithmetic relationship (allowed price minus copay equals plan payment) is shown as a plain sentence rather than an interactive calculator. A calculator here would have to invent inputs the document does not have.