# Patient Liability from Claims: Member Responsibility

Patient liability is the amount a claim assigns to the member, not necessarily an unpaid bill. Flexpa's financial data guide shows how to read member responsibility from ExplanationOfBenefit adjudication values and separates liability from payments already made.

How it works: Claim adjudication -> Member liability -> Separate payment values. Member liability and an unpaid balance are not interchangeable.

## Who owes what

| Party | Also called |
|---|---|
| Member | Patient |
| Insurer | Payer |
| Provider | Healthcare service provider |

## Member liability

The guide models member liability as noncovered, deductible, copay, and coinsurance amounts. Read the claim's adjudication values and distinguish this responsibility from amounts the patient has already paid.

### Read an ExplanationOfBenefit

```bash
curl https://api.flexpa.com/fhir/ExplanationOfBenefit/{id} \
  -H "Authorization: Bearer $ACCESS_TOKEN"
```

## Normalized for you

For supported payers, Flexpa translates each payer's adjudication codes to a standard set and calculates missing financial values from the liability and payment equations before returning the resource.

## Questions

**How do I get patient responsibility from claims data?** Flexpa's financial data guide shows how to read memberliability from ExplanationOfBenefit totals or calculate it from noncovered, deductible, copay, and coinsurance amounts. Liability is not necessarily the unpaid balance: payments are separate values.

**Does Flexpa normalize adjudication codes?** For supported payer endpoints, Flexpa normalizes adjudication codes and calculates missing financial values using the equations documented in its financial data guide. This does not mean every payer has the same normalization coverage.

## More

- [Liability (financial data guide)](https://www.flexpa.com/docs/guides/financial#liability)
- [Benefits navigation solutions](https://www.flexpa.com/solutions/benefits-navigation)
- [Why the EOB is the best HSA receipt (blog)](https://www.flexpa.com/blog/eob-best-hsa-receipt)
- [Claims data guide](https://www.flexpa.com/docs/guides/claims)

Last updated 2026-11-11.