Understanding Your Explanation of Benefits (EOB)

An Explanation of Benefits (EOB) is a detailed statement showing how recent medical claims were processed by Sana. An EOB is not a bill—it outlines what services were billed by your provider, what Sana covered, and the maximum portion you may owe directly to your doctor or facility.

Section 1: Header Details (Top Left)

This section contains identifying information to help you verify who received care and locate the corresponding claim in your account:

• Member/Dependent Name: Indicates which family member received the medical care.
• Claim Number: A unique tracking number that directly matches the claim record listed in your Sana Member Portal.
• Service & Provider Name: Identifies the specific doctor, hospital, or facility that performed the service, as well as the service title.

Section 2: Claim Financial Breakdown 

This section shows the high-level financial calculation used to determine allowable charges:

• Service Date: The specific date the medical service or procedure took place.
• Billed Charges: The total gross amount originally billed by your provider.
• Other Adjustments: Savings and contractual discounts applied to align the charge with Sana’s approved reimbursement rates.
• Allowed Amount: The maximum dollar amount Sana deems acceptable for the service provided. 

Section 3: Your Out-of-Pocket Breakdown (“Patient Responsibility”)

This section details how your personal cost-sharing was calculated based on your plan design:

• Ineligible Charges: Non-covered expenses or adjustments that you are not responsible for paying.
• Copay: A fixed flat fee paid upfront for specific office visits.
• Deductible: The portion of the allowed charge applied toward your individual or family annual deductible.
• Coinsurance: Your percentage share of costs after reaching your deductible.
  • Note for High Deductible Health Plans (HDHP): Once your annual deductible is fully met, covered services are paid at 100% by the plan with no coinsurance applied.
• Total Patient Responsibility: Highlighted clearly in a dedicated box at the bottom of the breakdown, this represents the final total amount you owe your provider.

Need to Appeal a Claim?

If you believe a claim was processed incorrectly or disagree with a coverage determination, your EOB outlines the formal appeal process at the very bottom of the document.

Before Filing a Formal Appeal: We strongly encourage you to contact Sana Support directly first. Our team can review the claim coding with you, verify processing accuracy, and often resolve errors without requiring a formal written appeal.