2023 Final Claim Funding Report
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Instruction:
[Instruction text]
2022 BCBS CLAIMS
2022 BCBS CONVERSION TO FULLY INSURED PLAN USING A HIGHER DEDUCTIBLE WITH A REIMBURSEMENT TO RECREATE THE EGYPTIAN TRUST BENEFIT
Below is the Benefit You Were Awarded at BCBS. This plan has a higher deductible than you were used to.
| Calendar year | Plan Name | Individual | Family |
| Max Deductible | Max Coinsurance | Max OOP | Max Deductible | Max Coinsurance | Max OOP |
| 2022 | No Data Available |
| 2023 | No Data Available |
As a result, your providers might have billed you for the higher amount of out of pocket that remained.
| Plan year |
Name |
Total BCBS Billed |
Total BCBS Allowed |
Total BCBS Paid |
Total Due Provider |
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Below You Will Find 3 Detailed Claim Balancing Reports:
Report 1 - November and December 2022
Report 2 - All Months of 2023
Report 3 - Combination of All 2022 and 2023 Claims
Report 1 - 2022 BCBS CLAIM TRACKER with Reimbursement
WE HAVE COMPARED BELOW THE AMOUNT BCBS INDICATES YOU OWE (IN BLUE) VERSUS THE AMOUNT THAT WOULD HAVE BEEN OWED UNDER THE EGYPTIAN TRUST (IN GREEN).
CLICK THE DETAILS BUTTON TO VIEW ACTUAL CLAIMS.
| Plan year |
Name |
BCBS |
Egyptian Trust |
OUT OF POCKET DIFFERENCE |
DO YOU QUALIFY FOR A REIMBURSEMENT? |
Final HRA Funding For Copay |
Final HRA Funding For Ded Coins |
| Total Billed |
Total Allowed |
Total Paid |
correction payment |
Total Due Provider |
Correct Total Deductible/Coins |
Correct Total Copay |
Correct Total You Should Owe |
AMT OWED AT BCBS MINUS EGYPTIAN TRUST |
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Report 1 - Detailed Break Down Per Claim for
| Processed Date |
Date of Service |
Name |
Claim Number |
Provider |
BCBS |
Egyptian Trust |
OUT OF POCKET DIFFERENCE |
DO YOU QUALIFY FOR A REIMBURSEMENT? |
Final HRA Funding For Copay |
Final HRA Funding For Ded Coins |
| Total Billed |
Total Allowed |
Total Paid |
Total correction payment |
Total Due Provider |
Correct Total Deductible/Coins |
Correct Total Copay |
Correct Total You Should Owe |
AMT OWED AT BCBS MINUS EGYPTIAN TRUST |
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Report 2 - 2023 BCBS CLAIM TRACKER with Reimbursement
WE HAVE COMPARED BELOW THE AMOUNT BCBS INDICATES YOU OWE (IN BLUE) VERSUS THE AMOUNT THAT WOULD HAVE BEEN OWED UNDER THE EGYPTIAN TRUST (IN GREEN).
CLICK THE DETAILS BUTTON TO VIEW ACTUAL CLAIMS.
| Plan year |
Name |
BCBS |
Egyptian Trust |
OUT OF POCKET DIFFERENCE |
DO YOU QUALIFY FOR A REIMBURSEMENT? |
Final HRA Funding For Copay |
Final HRA Funding For Ded Coins |
| Total Billed |
Total Allowed |
Total Paid |
correction payment |
Total Due Provider |
Correct Total Deductible/Coins |
Correct Total Copay |
Correct Total You Should Owe |
AMT OWED AT BCBS MINUS EGYPTIAN TRUST |
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Report 2 - Detailed Break Down Per Claim for
| Processed Date |
Date of Service |
Name |
Claim Number |
Provider |
BCBS |
Egyptian Trust |
OUT OF POCKET DIFFERENCE |
DO YOU QUALIFY FOR A REIMBURSEMENT? |
Final HRA Funding For Copay |
Final HRA Funding For Ded Coins |
| Total Billed |
Total Allowed |
Total Paid |
Total correction payment |
Total Due Provider |
Correct Total Deductible/Coins |
Correct Total Copay |
Correct Total You Should Owe |
AMT OWED AT BCBS MINUS EGYPTIAN TRUST |
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Report 3 - Combined 2022-2023 BCBS CLAIM TRACKER with Reimbursement
WE HAVE COMPARED BELOW THE AMOUNT BCBS INDICATES YOU OWE (IN BLUE) VERSUS THE AMOUNT THAT WOULD HAVE BEEN OWED UNDER THE EGYPTIAN TRUST (IN GREEN).
CLICK THE DETAILS BUTTON TO VIEW ACTUAL CLAIMS.
| Plan year |
Name |
BCBS |
Egyptian Trust |
OUT OF POCKET DIFFERENCE |
DO YOU QUALIFY FOR A REIMBURSEMENT? |
| Total Billed |
Total Allowed |
Total Paid |
Corrected payment |
Total Due Provider |
Correct Total Deductible/Coins |
Correct Total Copay |
Correct Total You Should Owe |
AMT OWED AT BCBS MINUS EGYPTIAN TRUST |
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Report 3 - Detailed Break Down Per Claim for
| Processed Date |
Date of Service |
Name |
Claim Number |
Provider |
BCBS |
Egyptian Trust |
OUT OF POCKET DIFFERENCE |
DO YOU QUALIFY FOR A REIMBURSEMENT? |
Plan year |
| Total Billed |
Total Allowed |
Total Paid |
Total correction payment |
Total Due Provider |
Correct Total Deductible/Coins |
Correct Total Copay |
Correct Total You Should Owe |
AMT OWED AT BCBS MINUS EGYPTIAN TRUST |
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5. CLAIM DETAILS BY PERSON/CATEGORY/PROVIDER - We are in the process of marking the reimbursement due. Your claims are NOT FINALIZED if you dot see RED LETTERING "FINAL- ALL REIMBURSEMENTS ATTRIBUTED" BCBS was delayed in releasing claims-Check back in 48 hours to view our finalized report!
Claims for
Claim Type:
| Processed Date |
Date of Service |
Plan Year |
Name |
Claim Number |
Provider |
Claim Type |
Total Billed |
Penalty |
Allowed Amount |
BCBS Paid |
Amount Due Provider |
Total Deductible Reimbursements |
Total Copay Reimbursements |
Employee Real Responsibility |
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Click
to view your available balance on your Summit MasterCard.
Click
to request emergency cash funding. (Only use this if you have already paid your provider direct and have a reimbursement reported above)
| Claim Type |
Date Of Service |
Place Of Service |
BCBS |
EGYPTIAN TRUST |
Final HRA Funding For Copay |
Final HRA Funding For Ded Coins |
Primary Diagnosis |
Procedure Description |
Procedure Code |
Penalty |
Medication Name |
Medication QTY |
Medication Supply |
LineId |
| Billed Amount |
Allowed Amount |
Carrier Paid |
BCBS Your Responsibility Prior To HRA |
Patient Final Ded After HRA |
Patient Final Coins After HRA |
Patient Final Copay After HRA |
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