Medical Expenses
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12/18/2015
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5/17/2016
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5/25/2016
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5/28/2016
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6/1/2016
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7/5/2016
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7/6/2016
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7/6/2016
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7/7/2016
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7/13/2016
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9/21/2016
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Patient
Provider
Service
Charge
EOB
Disallowed
Approved
Extra owed
Total owed
Deductible
Co-ins
Co-pay
Ins to provider
Ins to us
We owe
We paid
Balance due
Adj.
Who is owed
Notes
Check sum
Check status
Timothy
Familydoc, Dr. Leah
Blood work
$90.00
1/7/2016
$90.00
$90.00
$31.50
$58.50
$31.50
$31.50
$0.00
paid 2/4/16
0.00
Abigail
NoMedicare, Dr. Amy
Check-up
$422.00
1/8/2016
$204.99
$217.01
$204.99
$422.00
$166.72
$17.60
$32.69
$389.31
$422.00
$0.00
Must pay entire "Disallowed" amount. $32.69 reimbursement received.
0.00
Abigail
Familydoc, Dr. Leah
Blood work
$90.00
1/7/2016
$90.00
$90.00
$90.00
$90.00
$90.00
$0.00
paid 2/4/16
0.00
Abigail
Anytown Hospital Center
X-ray
$375.80
1/26/2016
$250.37
$125.43
$50.00
$175.43
$9.93
$115.50
$59.93
$59.93
$59.93
Never billed for the $59.93.
0.00
Timothy
Doe, Dr. William
Consultation
$240.00
5/25/2016
$122.09
$117.91
$117.91
$30.00
$87.91
$30.00
$30.00
$0.00
Visit because of nnnnnnnn.
0.00
Timothy
Anytown Hospital Center
EKG
Cardiology
$1,479.40
5/23/2016
$572.59
$906.81
$906.81
$19.54
$133.09
$754.18
$152.63
$152.63
$152.63
Notes Never billed for the $152.63. An Adj. for this amount was entered to "clear" the Who is owed and the Check sum fields.
-0.00
Timothy
Bush, Dr. Avery
Procedure
$525.86
5/31/2016
$367.37
$158.49
$158.49
$23.78
$134.71
$23.78
$23.78
$0.00
Procedure description.
0.00
Timothy
Scanner, Dr. Filme
Cardiology
$67.85
6/7/2016
$30.62
$37.23
$37.23
$5.58
$31.65
$5.58
$5.58
$0.00
0.00
Timothy
Your Hometown Pharmacy
Pharmacy
$1.63
5/28/2016
$1.63
$1.63
$1.63
$1.63
$1.63
$0.00
drug name
0.00
Timothy
Bush, Dr. Avery
Cardiology
$351.91
8/19/2016
$209.79
$142.12
$142.12
$2.97
$30.00
$109.15
$32.97
$32.97
$0.00
follow-up; Corrected EOB. Paid online by ?????? on ??/??/????.
-0.00
Abigail
Eye doctors of Anytown
Eye exam
$263.00
7/6/2016
$263.00
$263.00
$63.00
$200.00
$63.00
$63.00
$0.00
0.00
Timothy
Eyedoc, Dr. Hugh
Retinal exam
$787.03
9/8/2016
$140.03
$647.00
-$27.30
$619.70
$226.45
$420.55
$199.15
$199.15
-$0.00
Paid by ????? credit card by phone on ??/??/????.
0.00
Timothy
Smythe, RN Johnathan
Dermatology
$95.83
7/29/2016
$72.63
$23.20
$38.00
$61.20
$23.20
$0.00
$61.20
$61.20
$0.00
0.00
Timothy
Sleepy, Dr. David
Anesthesia
$841.00
8/12/2016
$771.54
$69.46
$69.46
$10.42
$59.04
$10.42
$10.42
$0.00
Anesthesia for ?????????
-0.00
Timothy
Surgeon, Dr. Peter
Cardiology
$340.80
7/22/2016
$202.66
$138.14
$138.14
$20.72
$117.42
$20.72
$20.72
$0.00
-0.00
Abigail
Dental, Dr. Edward
Dental
$177.00
7/20/2016
$7.00
$170.00
$7.00
$177.00
$85.00
$85.00
$92.00
$177.00
$0.00
routine exam
0.00
Timothy
Radman, Dr. Ray X.
Radiology
$320.00
9/7/2016
$222.84
$97.16
$97.16
$14.57
$82.59
$14.57
$14.57
$0.00
paid by ????? on ??/??/????.
0.00
Abigail
Pharmacy of Anytown
Vaccination
$38.99
9/19/2016
$38.99
$38.99
$38.99
$0.00
$0.00
Vaccination description
0.00
Timothy
Your Hometown Pharmacy
Pharmacy
$181.62
9/16/2016
$0.00
$181.62
$181.62
$10.00
$171.62
$10.00
$10.00
$0.00
drug paid by ??????.
0.00
Timothy
Diagnostic Testing
Blood work
$50.00
12/8/2016
$19.82
$30.18
$30.18
$30.18
$0.00
$0.00
follow-up visit
0.00
Timothy
Bush, Dr. Avery
EKG
Cardiology
$48.28
11/30/2016
$28.45
$19.83
$19.83
$19.83
$0.00
$0.00
EKG for ?????????
-0.00
Timothy
Durable Medical Providers
Chronic condition
$21.57
1/31/2017
$7.55
$14.02
$14.02
$14.02
$0.00
$14.02
$14.02
$0.00
description of visit and payment.
0.00
Abigail
Anytown Hospital Center
Radiology
$249.50
2/13/2017
$8.40
$241.10
$241.10
$241.10
$241.10
$100.00
$141.10
We owe
-141.10
Abigail
NoMedicare, Dr. Amy
Check-up
$200.00
$200.00
$200.00
$0.00
$200.00
-$200.00
Owed us
awaiting insurance determination.
0.00
Check sum failed
Timothy
Future, Dr. Ralph
Cardiology
$0.00
$0.00
$0.00
$0.00
placeholder for future appointment
0.00
$0.00
$0.00
$0.00
$0.00
0.00
26 records
Summary
Summary
Summary
Summary
Sum
$7,259.07
Summary
Sum
$3,238.74
Sum
$4,020.33
Sum
$272.69
Sum
$4,293.02
Sum
$541.31
Sum
$557.90
Sum
$171.61
Sum
$2,431.82
Sum
$117.69
Sum
$1,543.51
Sum
$1,507.54
Sum
$153.66
Sum
$212.56
Summary
Summary
Sum
-141.10
Summary
Alert
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