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Table - Coverage

Coverage Summary

Effective Date 1/1/2015 Effective Until 1/1/2016
Coverage Status Insured Group Number 100
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Table - Claims

Recent Claims

Claim Number Date of Service Provider Claim Status Amt Paid
N636156004 5/13/2015 Karen Adkins MD DENIED $0.00
N636186001 5/13/2015 Robert Love MD CHECK WRITTEN $300.00
8128013376 2/3/2015 Sammie Twiggs MD DENIED $1,296.78
7973735542 1/16/2015 Sammie Twiggs MD DENIED $98.69
4630350636 8/8/2014 Sammie Twiggs MD PAID $87.26

 

Claim # N636156004 N636156004 N636156004
Date of Service 4/13/2015 4/13/2015 4/13/2015
Provider Karen Adkins MD Karen Adkins MD Karen Adkins MD
Claim Status Denied Accepted Accepted
Amount Paid $0.00 $111.11 $65.66
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