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Patient Account List Please find your account number to check your claim and/or preauthorization status

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

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

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

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.)

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

9117 Need Patients medical insurance card Need Patients medical insurance card

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: $ Exam 07/28/08: $ – Last Sent 2/3/09 with description of services: no response

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

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

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