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Member Summary For: |
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JOHN DOE |
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Relationship: EMPLOYEE |
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Date of Birth: 01/01/1970 |
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Account Number: 1234567 |
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Effective Date: 01/01/2002 |
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Eligibility Status: Active |
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Physician: SMITH DAVID MD |
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Resources |
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| Search Criteria:
Medical claims for: JOHN DOE
from 09/01/2003
to 11/01/2003
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| Claim Information |
| Click on "Details" links for complete information of the claim listed, including payment information and amounts covered. |
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| Date(s) of Service |
Date Processed |
Total Charge |
Total Paid |
Servicing Provider |
Details |
09/02/2003
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09/08/2003 |
$500.00 |
$450.00 |
Susan Brown |
Details |
09/17/2003
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09/21/2003 |
$278.95 |
$251.05 |
Susan Brown |
Details
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