Patient responsibility
Updated September 30, 2026
Definition
The part of a claim your insurer says you owe, such as your deductible, copay, or coinsurance. Your explanation of benefits may call it "what you owe."
Patient responsibility is the amount your insurer says is your share of a claim. It usually adds up your deductible, copay, and coinsurance for that visit. It can also include care your plan didn't cover.
You'll see it on your explanation of benefits (EOB), often labeled "what you owe" or "you may owe." Insurers tag each part of a claim with a standard group code. Amounts you owe carry the code PR, short for patient responsibility. Amounts marked CO, for contractual obligation, are the provider's to absorb, not yours.
For example, say a visit's allowed amount is $400. Your plan applies $100 to your deductible, then you owe $60 in coinsurance. Your patient responsibility is $160. Compare that with the amount due on your bill. Payments you made at the visit may not show on the EOB, so subtract them yourself. If the bill is still higher, ask the billing office why before you pay.
Related terms
Guides that use this term
- GuideMedical bill vs. EOB: how to compare them line by lineYour bill and your EOB should tell the same story. Here's how to compare them in 20 minutes, with a worked example and what to do if they don't match.
- GuideDenial codes on your EOB, explainedWhat do CO-45, PR-1, and CO-16 mean? Look up common claim denial codes, learn who's responsible for each amount, and see what to do about each one.
Sources
- Claim adjustment reason codes, X12. Accessed September 30, 2026.
- Reading your explanation of benefits (EOB), Centers for Medicare & Medicaid Services. Accessed September 30, 2026.
This is general information, not legal or medical advice. Rules can depend on your plan and your state. Romi Care isn't an insurer, law firm, collection agency, or government program.