Collective
Protective Records Collective
Protective Records
| February '03 | Personal | March '03 | Contact | |||||||
 |
 |
|
(CP Use) |
|
Dale Sprague |
PSN: 08202-1NJ-A020 |
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Collective Protective User Identification #23658 |
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Date prepared: 03/14/2003 |
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This is an explanation of recent activity and benefits received for February 2003
|
Patient: Diana | |
IRN: 2003-00308-9132970 |
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| Bills Submitted | Billed Charge | |
Negotiated Charge | |
Not Covered | |
Pending | |
Co-Pay | |
Deductible Amount | |
Balance | ||
| BAYLOR - GWG | |||||||||||||||
| 02/04 | |||||||||||||||
| Medical | $8.00 |
$7.00 |
$7.00 |
||||||||||||
| Medical | $62.00 |
$62.00 |
$13.00 |
$49.00 |
|||||||||||
| Totals | $70.00 |
$69.00 |
$0.00 |
$0.00 |
$0.00 |
$20.00 |
$49.00 |
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|
Patient: Dale | |
IRN: 2003-00415-7764590 |
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| Bills Submitted | Billed Charge | |
Negotiated Charge | |
Not Covered | |
Pending | |
Co-Pay | |
Deductible Amount | |
Balance | ||
| WASSILUK- GWG | |||||||||||||||
| 02/14 | |||||||||||||||
| Emergency Room | $234.00 |
$175.00 |
$175.00 |
pending |
|||||||||||
| Medical | $92.00 |
$89.00 |
$89.00 |
pending |
pending |
||||||||||
| Totals | $326.00 |
$264.00 |
$0.00 |
$264.00 |
$0.00 |
pending |
pending |
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Other activity in February 2003
-- GWG 02/15/2003: Dale; Admission to Greatwater
General Medical Center, Aglaura NJ 08088;
Billing Status: pending
-- GWG 02/18/2003: Dale; Discharge from Greatwater
General Medical Center, Aglaura NJ 08088;
Billing Status: pending
For Customer Service, call 206-424-4846 or e-mail: support@collectiveprotective.com