Medical & prescriptions
How do I read a medical bill?
Compare the provider bill with your claim statement before paying.
At a glance
Claim statement
Not a bill
In-network claim
Provider submits
Questions
Call BCBS
How a claim moves
- You receive care; an applicable copay may be due at the visit.
- The in-network provider submits the claim to BCBS. You may need to submit an out-of-network claim yourself.
- BCBS processes the claim and sends a Statement of Health in the book’s claims terminology.
- The provider sends a bill, typically within two weeks after the statement.
Two examples in the book
Example one: a $75 bill, after the deductible is met, produces a $60 plan payment and a $15 member payment. Example two: for Healthy Savings employee-only coverage, a covered $125 visit costs $125 before the deductible, $25 during 20% coinsurance, or $0 after the $4,500 out-of-pocket maximum. These are illustrations, not your bill.
Before paying
- 1
Compare the provider’s charge to the member-responsibility amount on the claim statement.
- 2
Ask BCBS about a mismatch before paying.
- 3
Pay with personal funds or available HSA / FSA funds where permitted.
- 4
Keep the statement and receipts for reimbursement or substantiation.
Do this
Make sure your provider bill matches the claim statement.
More detail
Different meanings of SOH
The book uses “Statement of Health” for a claims statement and separately for an insurance health questionnaire. It does not reconcile the terminology. Keep those two contexts distinct.
Online family statements
Each covered family member can view their statements after signing in. The source says minors under 12 can be viewed through the employee account and children over 12 need their own account. It does not resolve the boundary at exactly age 12.