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Summary of Health Plan Payments

The Summary of Health Plan Payments1 explains how we processed certain claims that were submitted after you received medical service. You will only get a Summary of Health Plan Payments when there’s a remaining balance after we cover our share. The example below will help you understand how to read each section.

This is not a bill. Your doctor or hospital will bill you for any outstanding balances. If you have any questions, please call Member Service at the number on the front of your ID card. You can also view your claims information on MyBlue by creating an account or logging in.

Download the Understanding Your Summary of Health Plan Payments guide.

 
 
  • The deductible is the amount of money you pay out-of-pocket for health care services, such as blood tests and X-rays, before Blue Cross starts to pay for them.
  • This section shows how the allowed amount was calculated.
  • This explains the billing breakdown of your service, including what you owe (if anything).
  • You'll find the meaning of any unfamiliar terms here.
  • This section shows recently submitted claim information for your medical services, including dates of services, health care providers, charges, and payment details.
  • The amount of money you have to pay for each claim.
  • This section shows what you owe out-of-pocket for each service.
  • You may find additional information on how we processed your claim(s) here.
  • This is the amount you owe toward this claim after we’ve covered our share. Your health care provider may bill you for this amount. If you have an additional health insurance plan that covers these services, this doesn’t apply to you.

1Medex®´ members receive statements titled Explanation of Benefits.


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