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Sample Family Clinic#CC-2026-00847

Amount due

$284.72

Due May 15, 2026 — avoid delays or additional fees
Service: April 3, 2026Statement: April 14, 2026

How your bill breaks down

Original charge

What the provider billed

$401.12

Your insurance paid

BlueCross Sample Plan

− $116.40

What you may need to pay

Your remaining balance

$284.72
Insurance 29%You 71%

Plain-English explanation

Why you owe this

  • Your deductible may not have been fully met
  • Insurance paid part of the allowed amount

What this means

You appear to be responsible for the remaining balance after your insurance applied its adjustments and payments.

Suggested next step

You may want to ask your provider's billing office to confirm how your deductible was applied, or contact your insurance plan to review your Explanation of Benefits (EOB).

This is an educational explanation, not a formal billing determination. Medelyn Health does not provide medical, legal, or insurance advice.

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