Explanation of Amount Billed, Plan Discount & Payment Terms

Amount Billed

The amount charged by the provider for the health care service or product. This amount does not show any plan discounts, if applicable.

Plan Discount

The difference between the amount billed and the amount the provider has agreed to accept as payment.

Plan Paid

The amount the plan paid for covered health care services or products. Does not include amounts paid from a Health Reimbursement Account (HRA), Health Savings Account (HSA), or Flexible Spending Account (FSA) account, if applicable.

You May Owe

The amount you may owe after network discounts or plan benefits apply and the plan pays a provider from a Health Reimbursement Account (HRA) or Flexible Spending Account (FSA), if applicable. This amount may reflect payments by other health insurance plans, if applicable. It may not match the bill you receive from your health care provider. The amount does not reflect payments you may have paid directly to your provider unless they were made via this website. Prescription amounts paid at the time of purchase show as zero.

You Paid

The copay amount you may have paid at point of service and any payments you have made via this website.

Summary Plan balances Claims Submit a Claim Documents
Summary Plan balances Claims Submit a Claim Documents

Displaying claims 17 of 17
From 05/24/2018 To 11/24/2019
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Explanation of Amount Billed, Plan Discount & Payment Terms

17 of 17 Claims

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Explanation of Amount Billed, Plan Discount & Payment Terms
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Select Dates From 05/24/2018 To 11/24/2019
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Dove's Claim Date of Service - 08/26/2019
Claim Status:Processed - 10/17/2019

Provider:Rwhg Cherry Hill

View Medical Claim # AA02082941View Medical Claim # AA02082941
Amount Billed
$3,000.00
Plan Discount
$2,915.16
Plan Paid
$67.87
You Paid
$0.00
You May Owe
$16.97
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Simenson's Claim Date of Service - 08/28/2019
Claim Status:Processed - 10/17/2019

Provider:Rwhg Cherry Hill

View Medical Claim # AA02082940View Medical Claim # AA02082940
Amount Billed
$3,000.00
Plan Discount
$2,915.16
Plan Paid
$76.36
You Paid
$0.00
You May Owe
$8.48
Pay NowOpens in a new window
Luz's Claim Date of Service - 08/20/2019
Claim Status:Processed - 10/17/2019

Provider:Rwhg Cherry Hill

View Medical Claim # AA02082939View Medical Claim # AA02082939
Amount Billed
$3,000.00
Plan Discount
$2,915.16
Plan Paid
$76.36
You Paid
$0.00
You May Owe
$8.48
Pay NowOpens in a new window
Walker's Claim Date of Service - 06/01/2019
Claim Status:Processed - 10/17/2019

Provider:Rwhg Cherry Hill

View Medical Claim # AA00820307View Medical Claim # AA00820307
Amount Billed
$3,000.00
Plan Discount
$2,915.16
Plan Paid
$67.87
You Paid
$0.00
You May Owe
$16.97
Pay NowOpens in a new window
Dove's Claim Date of Service - 08/12/2019
Claim Status:Processed - 09/12/2019

Provider:Rwhg Cherry Hill

View Medical Claim # AA02082937View Medical Claim # AA02082937
Amount Billed
$3,000.00
Plan Discount
$2,915.16
Plan Paid
$59.39
You Paid
$0.00
You May Owe
$25.45
Pay NowOpens in a new window
Simenson's Claim Date of Service - 08/13/2019
Claim Status:Processed - 09/12/2019

Provider:Rwhg Cherry Hill

View Medical Claim # AA02082936View Medical Claim # AA02082936
Amount Billed
$3,000.00
Plan Discount
$1,000.00
Plan Paid
$1,600.00
You Paid
$0.00
You May Owe
$400.00
Pay NowOpens in a new window
Luz's Claim Date of Service - 08/11/2019
Claim Status:Processed - 09/12/2019

Provider:Rwhg Cherry Hill

View Medical Claim # AA02082935View Medical Claim # AA02082935
Amount Billed
$3,000.00
Plan Discount
$2,915.16
Plan Paid
$76.36
You Paid
$0.00
You May Owe
$8.48
Pay NowOpens in a new window
Walker's Claim Date of Service - 08/10/2019
Claim Status:Processed - 09/12/2019

Provider:Rwhg Cherry Hill

View Medical Claim # AA02082934View Medical Claim # AA02082934
Amount Billed
$3,000.00
Plan Discount
$2,915.16
Plan Paid
$67.87
You Paid
$0.00
You May Owe
$16.97
Pay NowOpens in a new window
Walker's Claim Date of Service - 05/15/2019
Claim Status:Processed - 06/19/2019

Provider:C Ford

View Medical Claim # AA00804998View Medical Claim # AA00804998
Amount Billed
$3,000.00
Plan Discount
$500.00
Plan Paid
$1,920.00
You Paid
$0.00
You May Owe
$580.00
Pay NowOpens in a new window
Dove's Claim Date of Service - 05/10/2019
Claim Status:Processed - 06/19/2019

Provider:C Ford

View Medical Claim # AA00804997View Medical Claim # AA00804997
Amount Billed
$3,000.00
Plan Discount
$1,600.00
Plan Paid
$1,260.00
You Paid
$0.00
You May Owe
$140.00
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