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CIGNA HealthCare Contact indicates where your claim was processed and what to do if you have questions.
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Date Processed is the date your claim was processed, not the date care was received.
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Employee Information includes the name and Social Security Number of the employee covered by the plan. The group number is the employer's unique plan account number. The information printed in this section should match what's printed on your CIGNA HealthCare ID card.
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Patient is the first name of the person who received the health care service(s) — either you or a covered family member.
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Inventory Number is the unique number we assign to each claim. If you have questions about your claim or EOB, be sure to have this number handy when you call CIGNA HealthCare Member Services.
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Provider is the name of the health care provider who submitted the claim. The provider may be a doctor, specialist, hospital, lab, clinic or other medical facility.
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Type of Service describes the health care service(s) the patient received from the provider.
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Service Date(s) is the actual date(s) the patient received health care service(s) from the provider.
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Total Charges are the total reasonable and customary fee providers charge to provide the type of service received.
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Contract Amount is the the specially negotiated fee the provider agrees to accept from CIGNA HealthCare to provide this type of service.
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Not Covered references any portion of the total charges ineligible for payment under your CIGNA HealthCare benefits plan. For example, Services not covered by your plan or services exceeding the maximum allowable reimbursement are not covered. Your provider may bill you for these charges.
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Covered Amount indicates the allowable charges for covered services.
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Deductible Amount is the amount of the charges we applied toward your deductible if your plan has an annual deductible. Once your deductible is met, your plan covers a percentage, or coinsurance amount, of eligible charges.
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Copay is the amount you or your covered family member is responsible for paying the provider at the time of service.
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Balance is the portion of allowable charges to be paid after any deductible has been applied.
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Paid At is the percentage of the balance covered by your particular CIGNA HealthCare benefits plan. For example: If your plan requires that you pay a 20% coinsurance amount for covered health care services, your claim will be "paid at" 80%.
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Total Payment is the total amount we paid to the provider or insured.
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Patient Responsibility to Provider is the amount you may owe the provider if your plan did not pay all the charges. But remember that your EOB is not a bill. Don't send your payment unless you receive a bill directly from the provider. If you are billed for more than this amount, ask the provider for a detailed explanation.
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Payment Summary Section indicates whom we paid and the total amount paid.
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Accumulations Section provides information about the deductibles taken and deductibles remaining for the year, if your plan has a deductible or maximum amount of coverage for a service.
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Remarks Section is reserved for any special information about how this claim was processed. Remember: If you have a question, refer to the top left box of this form (Contact) for information about calling CIGNA HealthCare Member Services.
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