1
4
This is the amount the provider charged.
3
This is the name of the doctor charge/test/ procedure that the hospital uses to denote what services are being charged for.
Make sure your patient information and insurance information is accurate.
5
This is the negotiated charge between your insurer and the provider.
7
Your deductible is how much you pay out of pocket up to a certain amount.
9
10
This is the amount you are responsible to pay.
2
This is the amount you are responsible to pay.
This is the amount covered by your plan.
This is the amount your insurance plan doesn't cover.
6
The reason code is why your insurance didn't cover a particular cost/service or means its subject to your deductible.
8
