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2 of 2 Claims
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Member's Claim Dates of Service
- 07/20/2018 - 07/22/2018
Claim Status:
Processed
- 07/22/2018
John Q Doctor
View Medical Claim # 1234567891
Amount Billed
$42.00
Plan Discount
$0.00
Plan Paid
$12.00
You Paid
$0.00
Why Do I Owe This Amount?
You May Owe
$30.00
View Explanation of Benefits
PAY NOW
Child's Claim Dates of Service
- 06/01/2018 - 06/07/2018
Claim Status:
Processed
- 06/07/2018
City Medical
View Medical Claim # 1234567892
Amount Billed
$3,408.58
Plan Discount
$925.08
Plan Paid
$1,284.00
You Paid
$0.00
You May Owe
$1,101.00
View Explanation of Benefits
PAY NOW
Member Demo's Claim Dates of Service
- 07/25/2018
- 07/28/2018
Claim Status:
Processed
- 07/29/2018
John Q Dentist
View Dental Claim # 1234567897
Amount Billed
$150.00
Plan Discount
$1,000.00
Plan Paid
$120.00
You Paid
$0.00
You May Owe
$30.00
View Explanation of Benefits
Child's Claim Dates of Service
- 06/01/2018
- 06/12/2018
Claim Status:
Denied
- 06/12/2018
Pharmacy A #6789
View Pharmacy Claim # 1234567894
Amount Billed
$38.03
Plan Discount
$0.00
Plan Paid
$25.03
You Paid
$10.00
You May Owe
$0.00
View Explanation of Benefits
Member's Claim Date of Service
- 05/15/2018
Claim Status:
Processed
- 05/25/2018
Demo, Member
View FSA Claim # 1234567895
Submitted
$300.00
FSA Paid
$120.00
Pending
$0.00
View Explanation of Benefits
Member's Claim Date of Service
- 05/15/2018
Claim Status:
Processed
- 05/25/2018
Demo, Member
View FSA Claim # 12345678911
Submitted
$12.08
FSA Paid
$12.08
Pending
$0.00
View Explanation of Benefits
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