Go anywhere near a doctor's office or hospital and expect to get a bunch of bills and statements. Here's my "note to self" on understanding a Blue Cross statement:
How To Understand A Blue Cross Claim Statement
(AKA Explanation of Benefits)
The main reason these statements are hard to understand is that someone has chosen totally inaccurate and misleading terms to describe the items on the statement. Use this sheet to understand what the terms really mean.
Explanation Of Benefits
The statement is called an "Explanation of Benefits," but it is really a claim statement showing how much Blue Cross has paid, and how much you will need to pay when you receive a bill from the service provider. If you want an explanation of benefits, see the Service Agreement.
Total Billed
This is not the total billed. This value should be labeled "The amount you would have been billed if you did not belong to Blue Cross." This value is totally irrelevant, and can be ignored. The only reason to include it is to make you feel that Blue Cross is paying more.
The True "Total Billed"
The real "total billed" is not displayed anywhere on the statement. To calculate it, add the "It is your responsibility to pay" amount to the "Paid Amount." If you call Blue Cross, they will refer to this as the Negotiated Fee Rate, which is not a "rate" so this should be called the "Negotiated Fee."
It is not your responsibility to pay
This value is also totally irrelevant, because it is based on the Total Billed amount. Ignore it.
Applied To Deductible
This is the amount you pay because your charges have not yet exceeded your deductible. That is, until you pay $2500 [old plan], you pay 100% of the true total billed. True, this is an amount that is applied to the deductible, but for the purposes of the statement, it should be labeled "Amount you pay because you haven't yet met your deductible."
Coinsurance Copayment Amount
[for old plan] You pay 30% of all amounts once you meet the deductible. This represents 30% of the amount over the deductible.
Member's Medical Deductible Applied To Date
This should be: Amount of payments that you've made that apply to your deductible.