1. Medical Billing Click Here to Search Click Here to Search

2. Patient Account List Please find your account number to check your claim and/or preauthorization status 5864 7102 7244 7918 8072 2698 4861 5628 5733 9756 9966 10411 10629 10630 8394 8434 9117 9195 9691 10847 10851 10867 10918 11627 20703

3. 2698 Exam 7/10/08: $47.00 Exam 7/10/08: $47.00 – Sent 7/15/08: no response

4. 4861 Exam 10/03/08:$148.00 Exam 10/03/08:$148.00 – Last Sent 11/12/08: no response Preauthorization for appliance: $800.00 Preauthorization for appliance: $800.00 – Last sent 2/3/09:Approved with a $1000.00 deductible Patient payment = $800.00 Patient payment = $800.00

5. 5628 Appliance 12/21/07: $500.00 Appliance 12/21/07: $500.00 – resent 2/5/09 with correct claim and letter

6. 5733 Exam 08/06/08: $30.00 Exam 08/06/08: $30.00 – Sent 9/19/08: denied-no prior authorization Patient payment = $30.00 (pd.) Patient payment = $30.00 (pd.)

7. 9756 Exam 7/7/08: $120.00 Exam 7/7/08: $120.00 – Last sent 7/15/08: no response

8. 9117 Need Patients medical insurance card Need Patients medical insurance card

9. 8434 Exam 6/19/08: $47.00 Exam 6/19/08: $47.00 – Last sent 2/3/09 with form letter: no response Exam 07/28/08: $116.00 Exam 07/28/08: $116.00 – Last Sent 2/3/09 with description of services: no response

10. 10918 Appliance: $750.00 Appliance: $750.00 – Medical Insurance: Denied – Dental Insurance: no response Patient Payment: $750.00 (pd.) Patient Payment: $750.00 (pd.)

11. 8394 Exam 7/7/08: $97.00 Exam 7/7/08: $97.00 – Last Sent 7/10/08: no response

12. 9691 Exam 10/17/07: $30.00 Exam 10/17/07: $30.00 – Sent 07/03/08: Denied- no preauthorization