340M54531
DOS DATE 1/15/2021
DOS DATE 1/15/2021
HOW MUCH IS BILLED AMOUNT?
6,513.51
How much did medicare allow?
144.20
How much is billed amount?
$285.18
HOW MUCH WAS PAID BY ANTHEM?
662.72
was the member responsible for anything? if so, how much?
NO, $0
How much did Anthem Pay?
$89.89
HOW MUCH WAS DISALLOWED?
5,760.79
What was the disallow amount? and why?
16.80 BECAUSE 45-Paid per your contract or Out Of Network rates
WHAT IS THE TOTAL PATIENTS LIABILITY?
$0
SOME MONTHS HAVE 31 DAYS, WHILE OTHERS HAVE 30. HOW MANY HAVE 28?
12 MONTHS