Fact Check: An Explanation of Benefits

Cigna Health and Life Insurance Company

Cigna Health and Life Insurance Company

THIS IS NOT A BILL.

Your health care professional may bill you directly for any amount that you owe.

Explanation of benefits

for a claim received fo

Patient’s relationship to Subscriber:

Subscriber Name:

Summary of a claim for services on July 12, 2023

for services provided by

Amount Billed

Discount

What your plan paid

What I owe

You saved

1

$500.00

$370.62

$129.38 Your plan paid $129.38 to

$0.00

Cigna.

Customer service

Call the number on the back of your ID card or (800) 244-6224 (1.800.CIGNA24) www.myCIGNA.com

If you have any questions about this document, please call Customer Service at the number above. Please have your claim number ready.

Service date

Claim #/ID

This was the amount that was billed for your visit on 07/12/2023.

You saved $370.62. CIGNA negotiates discounts with health care professionals and facilities to help you save money.

PLEASE SEE CLAIM DETAILS ON PAGE 3.

Provider Network Status: OUT OF NETWORK

Account name / Account #

This is the amount you owe after your discount, your plan paid, and what your accounts paid. People usually owe because they may have a deductible, have to pay a percentage of the covered amount, or for care not covered by their plan. Any amount you paid sin care was received may reduce the amount you owe.

You saved $500.00 (or 100%) off the total amount billed. This is a total of your discount and what your plan paid.

100% To maximize your savings, visit www.myCIGNA.com or call customer service to estimate treatment costs, or to compare cost and quality of in-network health care professionals and facilities.

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