Patient Statement
Sandra Lee
ACC-10043 · Cigna
Sent
Due July 20, 2025
Provider Note — Patient Confusion Hotspot
This is where most patient disputes originate. Use plain-language explanations below to prevent inbound calls. If insurance denied a line, make sure it is called out clearly.
What Was Billed
Office Visit — Primary Care
Visit: Jun 15, 2025
$250.00
What Insurance Covered
Insurance paid (Cigna)− $175.00
What You Owe
$75.00
This is the remaining balance after your insurance paid their portion. This is your responsibility under your Cigna plan (deductible, copay, or coinsurance).
Autopay scheduled for Jul 5 via ACH ••7712
Patient-facing statement
The simplified version the patient sees on their phone.