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Understanding your insurance

Understanding your personal health statements (PHS)

Your Personal Health Statement (PHS) is designed to help you better understand your recent medical and prescription claims including:

  • Total amounts charged
  • Your discounts just for being a member
  • What your health plan paid on your claims
  • And what you owe, or may have paid, to your medical provider

Arkansas Blue Cross and Blue Shield is providing you with this information so you can be a more informed member when it comes to paying for healthcare costs.

Sample PHS

Example PHS

PHS description

The following is a description of the items listed on the PHS. The field numbers referenced within the sample PHS pages correspond with the field names and descriptions provided below.

FIELD NUMBERFIELD NAMEFIELD DESCRIPTION
1Patient's NameThe name of the person who received the service. This could be the policyholder, covered spouse or a covered dependent child.
2Date Span for PHSThis date span is the week(s) from when the last PHS ran to the current PHS run representing our accumulation period.
3ID NumberThe member number of the person that received the services billed on the PHS.
4PHS Statement NumberThe number Arkansas Blue Cross and Blue Shield assigned to the PHS for tracking purposes.
5Contact InformationAll contact information for Arkansas Blue Cross and Blue Shield.
6Span for BenefitsCurrent contract span for the claims listed on the PHS.
7CopaymentA copay is a fixed amount you pay for a healthcare service, usually when you receive the service.
8DeductibleThe total deductible accumulation during the contractual year.
9Out-Of-Pocket MaxThe total out of pocket accumulation during the contractual year. Once the out-of-pocket is met Arkansas Blue Cross and Blue Shield will pay 100% of allowed services.
10Payment SummaryA brief summary of the way the claims on the PHS processed.
11Your Health MattersHelpful information to help the member better manage their health.
12ProviderThe healthcare professional or facility that provided services to the patient.
13Claim NumberThe number Arkansas Blue Cross and Blue Shield assigned to this claim for tracking purposes.
14Procedure DescriptionA description of the type of service for each claim.
15Service dateThe date the service was performed.
16Claim ReceivedThe date Arkansas Blue Cross and Blue Shield received the claim.
17Provider BilledThe amount the provider charged for the service.
18Member DiscountThe difference between the amount the provider billed and the net amount charged.
19Net Amount ChargedThe amount billed after the member discount is deducted.
20HRA PaidThe amount of HRA dollars used on this service line. If the member has a Health Savings Account then this field will always have a dash on each service line.
21Your Health Plan PaidThe amount Arkansas Blue Cross and Blue Shield paid based on the benefit coverage and the contractual agreement with the provider.
22Explanation CodesThis is an explanation of activity that occurred on this claim/service and describes how the claim was processed.
23Other Insurance PaidThe amount paid by the members other primary insurance carrier (if applicable).
24Copay/Excluded ServicesA copay is a fixed amount you pay for a healthcare service, usually when you receive the service. Excluded services are services that are not covered under the benefit plan.
25DeductibleThe amount the member pays to providers for services each benefit period before Arkansas Blue Cross and Blue Shield starts paying a portion of the coinsurance.
26CoinsuranceThe percentage of allowable charges the member pays to the provider for covered services for which the member is responsible.
27TotalThe amount the member pays to the provider for each line of service. This includes any non-covered services, deductible, & coinsurance.
28TotalsAccumulates the totals for each column.
29Total Charge After DiscountTotal charge after the member discount is applied for all claims on the PHS.
30Your Health Plan(s) PaidTotal Arkansas Blue Cross and Blue Shield paid for all claims on the PHS.
31You Owe or May Have PaidTotal the member owes for all claims on the PHS.
32Total member responsibilityThis amount is the same amount from Box #31.