The Personal Health Statement (PHS) is designed to make claims processing easier
to understand. With the PHS, industry terms are written into everyday language,
claims are clearly explained, and members know exactly where they are with their
out-of-pocket costs (deductibles, copays, coinsurance and more). The PHS features
a better description of the discounts members receive on their healthcare services,
information on how to get in touch with us, a quick understanding of how much members
owe and to whom and helps in understanding the benefits members have and how they
The PHS is issued twice a month for any physician, hospital or pharmacy claim submitted.
If a member only has pharmacy claims during a month, the PHS will be issued quarterly.
The total amount of charges for the services included.
The amount deducted from the total bill, which includes reduced rates for services
from in-network providers as well as any charges dismissed based on your plan coverage.
The amount your doctor or hospital charged (minus the discount).
The amount your plan paid for this service, according to your benefits.
The amount you or your additional insurance carrier must pay the provider for this
claim, excluding your copay.
The section helps you better understand exactly where you are with your out-of-pocket
costs: deductibles, copays and coinsurance.
The healthcare professional or facility that provided services to the patient.
The number Arkansas Blue Cross assigned to this claim for tracking purposes.
A description of the type of service for each claim.
The date that the patient received services.
The date the claim was received by Arkansas Blue Cross.
The amount the provider charged for the service.
The amount the provider must write off and/or the amount that has been withheld
from the provider payment subject to the terms and conditions of the contractual
agreement with the provider. The provider cannot bill you for this amount.
The customary amount for a service from which your coinsurance, if applicable, will
The amount we paid, based on your coverage and the contractual agreement with the
provider. Also shown is the date the claim was paid or denied.
The amount paid by another insurance carrier.
Copay - The amount you pay to the provider each time you receive a certain service.
Excluded Services - Any charges dismissed for non-covered services or the amount
that is above the allowed charge when seeing an out-of-plan provider based on your
The amount, if applicable, you pay to providers for services each benefit period
before we start paying in our share.
The percentage of allowable charges you pay to the provider for covered services
for which the member is responsible. Allowable charges include the amounts withheld
from provider payment, which are subject to the terms and conditions of the contractual
with the provider.
The amount you pay to the provider for this claim. This includes any copay, coinsurance,
deductible, non-covered services or the amount above the allowable.
Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties of Arkansas.
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