What does “claimed” and “paid” mean in the context of health insurance?

Question

For example: in my health insurance account under “claims” this is what I see for a recent visit:

Date Of Service:

05/27/2023

Status:

Processed

Claimed:

$454.95

Paid:

$156.65

When I go into explanation of benefits for this visit, it says patient balance is $39.16. How does that even relate to the above?

In: 0

Answer 1

Claimed is the “full price” of the service. Paid is the negotiated rate the insurance company actually paid to the doctor. Your balance would also get paid to the doctor. So while they initially billed $455, they’ll end up getting about $195.