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Members

Transparency in Coverage

Information on Explanations of Benefits (Our Personal Health Statements)

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 work.

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.

Learn more about your PHS Learn more about your dental EOB

Learn More About Your Personal Health Statement

PHS Description

1
Total Amount Changed

The total amount of charges for the services included.

2
Member Discount

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.

3
Net Charged

The amount your doctor or hospital charged (minus the discount).

4
Your Plan Paid

The amount your plan paid for this service, according to your benefits.

5
You Owe

The amount you or your additional insurance carrier must pay the provider for this claim, excluding your copay.

6
At-A-Glance

The section helps you better understand exactly where you are with your out-of-pocket costs: deductibles, copays and coinsurance.

7
Provider of Service

The healthcare professional or facility that provided services to the patient.

8
Claim Number

The number Arkansas Blue Cross assigned to this claim for tracking purposes.

9
Service

A description of the type of service for each claim.

10
Date of Service

The date that the patient received services.

11
Date Received

The date the claim was received by Arkansas Blue Cross.

12
Your provider billed

The amount the provider charged for the service.

13
Member Discount

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.

14
Net Charged

The customary amount for a service from which your coinsurance, if applicable, will be determined.

15
Arkansas Blue Cross Paid

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.

16
Other insurance paid

The amount paid by another insurance carrier.

17
Copay/Excluded services

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 plan coverage.

18
Deductible

The amount, if applicable, you pay to providers for services each benefit period before we start paying in our share.

19
Coinsurance

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.

20
You Owe

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.