Member Details
Jason Doe
Active
35 Years (10/25/1989)
|Gender:
Male
|
Marital
Status:
Married
|
Dependent
Of:
Alex Jenning
Member ID:
721533
|
Optum RX Number:
548745874895
|
SSN:
643-62-6668
Member Type:
Employer Group
|
Company:
Brokers Logistics,
Ltd.
|
Broker:
Max Bhupa
Contact Information
Home
Phone:
(915) 216-8365
Cell
Phone:
(915) 216-8745
Email:
jason.doe@gmail.com
Alt
Phone:
(915) 854-5478
Work
Phone:
(915) 854-5847
Email:
jason.doe@gmail.com
Address & Residence
Address:
13023 Aberdare Dr, EI
Paso, TX, 79928
Residence
Type:
Home
Apartment
#:
2548
Plan Details
Plan
Type:
Comprehensive Gold Dep
Plan
Information: Domestic
Price:
$65.00 / Month
Final
Price:
$65.00 / Month
Effective
Date: 3/1/2018
End Date:
10/31/2024
Digital Cards
| Claim Number | Practice Name | Date of Service | Status | Total Charge | Allowed Charge | Member Responsibility | Five Point Responsibility |
|---|---|---|---|---|---|---|---|
| 222-027-R-000168-005 | Texan Cardiovascular Institute PA | 1/17/2024 | In Process | $1,344.00 | $0.0 | $1,344.00 | $0.0 |
| 222-027-R-000168-010 | Apex Care Associates | 1/17/2024 | Paid | $1,344.00 | $0.0 | $1,344.00 | $0.0 |
| 222-027-R-000168-025 | Sunrise Family Clinic | 1/17/2024 | Denied | $1,344.00 | $0.0 | $1,344.00 | $0.0 |
| 222-027-R-000168-040 | Green Valley Health Center | 1/17/2024 | Paid | $1,344.00 | $0.0 | $1,344.00 | $0.0 |
| 222-027-R-000168-105 | Harmony Medical Group | 1/17/2024 | Paid | $1,344.00 | $0.0 | $1,344.00 | $0.0 |
| 222-027-R-000168-085 | Riverbend Wellness Clinic | 1/17/2024 | In Process | $1,344.00 | $0.0 | $1,344.00 | $0.0 |
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