CLAIMS CENTER - Claim Detail
Member Information
Member NAVEED KHAN
name:
Group
number:
ID
number:

Claim Payment Summary
The amount shown under "Amount You May Owe" will reflect
costs not covered by your plan.
Below is a summary that shows how your claim was billed. The
rates you agreed on with your doctor or hospital may vary from
the amount billed.

Claim Information
Claim
number:
BCBS Paid
status:
04/11/2018
Last
update
date:
Claim Medical

Questions about what your plan covers? Check your plan
documents. Or call us at the number on your member ID card.
A table displaying your billed amount, BCBS Discount and 3rd
Party Payments, coinsurance paid by plan, your responsibility,
and the amount you may owe from top to bottom.

type:
Add to Claim Group
Claim
group:
Create a Claim Group to better manage and view your claims.

Billed Amount

$56,603.53

Amount You May Owe:

$44,521.47

For Claim Payment Summary details, please refer to your
Explanation of Benefits.

Provider Information
ProviderAIR EVAC EMS INC
name:
Date of 11/15/2017
service:
There are no service line details available for you at this time.

Explanation of Benefits

My Notes

View your EOB document to see how this claim was processed,
including expenses submitted by your provider, benefits
approved, and any amount you may still owe.

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Enter a new note here. Up to 150 characters.

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an Independent Licensee of the Blue Cross and Blue Shield Association.
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