Patient Statement
Thomas Grant
ACC-10049 · Aetna
Sent
Due July 15, 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
Lab Work — Comprehensive Panel
Visit: May 28, 2025
$890.00
What Insurance Covered
Insurance paid (Aetna)− $350.00
Insurance denied$540.00
Why? The insurer determined this service was not covered under your current plan. You can appeal this decision within 60 days.
What You Owe
$540.00
This is the remaining balance after your insurance paid their portion. This is your responsibility under your Aetna plan (deductible, copay, or coinsurance).
Patient-facing statement
The simplified version the patient sees on their phone.