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Reimbursement math

Expected vs. actual reimbursement

How Heel calculates what you should get back before the EOB arrives.

For every eligible line item, Heel computes the expectedreimbursement as soon as you save the invoice — before the EOB exists. The formula is intentionally simple:

  1. Sum the eligible line items.
  2. Subtract any unmet deductible from this policy year.
  3. Multiply by your reimbursement %.
  4. Cap at your remaining annual maximum.

When the EOB lands, Heel reads the actualamount the insurer paid and lines it up next to the expected number. If they match, the invoice is reconciled. If they don't, the variance gets explained — see the next article.

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