Understanding Your Claim Breakdown

When you view a claim in your Sana portal, you’ll see an itemized summary of what your provider charged, the Sana member discount, and what portion (if any) you owe. Below, you will see an example of the following breakdown:

• Total Billed by Provider: $1,000.00
• Sana Member Discount: -$400.00
• Adjusted Total: $600.00
• Covered by your plan: $350.00
• Covered by You (Member Responsibility): $250.00
  • ⚙️ Applied to your deductible: $200.00
  • ⚙️ Copay / Coinsurance: $50.00

Field-by-Field Breakdown:

• Total Billed by Provider: The original full charge submitted by your healthcare provider before any insurance discounts or insurance coverage are applied.
• Sana Member Discount: The amount discounted based on negotiated network rates between Sana and your provider. You are never responsible for paying this amount.
• Adjusted Total: The remaining balance eligible for coverage after the Sana Member Discount is subtracted (Total Billed minus Sana Member Discount). This represents the true cost under your plan.
• Covered by Your Plan: A portion of the adjusted total that Sana paid directly to your doctor, facility, or healthcare provider on your behalf.
• Covered by You (Member Responsibility): Your total personal financial responsibility for this service (Adjusted Total minus Covered by Your Plan). This is the maximum total amount you should owe your provider.

Where "Covered by You" Goes:

Your total out-of-pocket responsibility is broken down into specific plan cost-sharing buckets:

• Applied to Your Deductible: This portion goes toward your annual deductible—the out-of-pocket amount you must reach before Sana shares a larger percentage of covered costs.
• Copay / Coinsurance: Your fixed copay fee or percentage-based coinsurance share required by your plan for this specific type of service.

Note for Members: An Explanation of Benefits is not a bill. It is an informational statement showing how your claim was processed. You should only pay your provider if they send you an official invoice, and the total billed to you should never exceed the "Covered by You" amount on your EOB.