What’s a Report to Member?

Once HMSA receives and processes a claim for services, you’ll receive a statement called a Report to Member that shows how much HMSA paid for services and the amount you’re responsible for. The Report to Member (RTM) is an explanation of benefits and is not a bill for services or supplies.

Information included on the Report to Member:

Information Description
Patient Person who received the service or supply.
Service Dates Date(s) the service or supply was received.
Provider Facility, physician, or other health-care professional who provided the service or supply.
Type of Service General description of the service or supply.
Charge Amount the provider billed for the service or supply.
Provider Adjustment Difference between the participating provider’s charge and HMSA’s eligible charge.
Eligible Charge Amount used to calculate HMSA’s payment and your copayment for covered services. HMSA participating providers have agreed to accept this amount as payment in full for covered services or supplies.
Your Benefit Amount paid by HMSA.
You May Owe Amount you owe for the service. Note: You already may have paid this amount. If not, you may be billed by your provider.
Message Codes Information about the payment or benefit for a particular service.

Note: The Report to Member should be filed because it’s an important document for reporting to supplemental or reimbursement plans, and for annual tax reporting as appropriate. If you have an active HMSA My Account, you can view your Report to Member statements on HMSA’s website. You can also contact HMSA Customer Relations for assistance.

For additional important information, we encourage you to read: