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Member ID: 53252345-01
  Name: Brown, Sue              
  • Benefit Summary 360
  • Overrides
  • COB
  • Match UM
  • EOB
  • Sign Payee
Relationship: Wife
   
Billing Information
Last Bill Date   08/01/2020
Net Amount Due   $1000.00
Current Suspense   $0
Processing Status   Normal Billing
     
  DOB: 01/01/1972
   
Claims Information
Claim ID Provider Begin Date Status Total Charge Claim Type SubType
130670000100 Smith, Joe 01/01/2021 01 - Acce... $1000.00 Medical H
142500000200 Jones, Brian 02/15/2021 15 - Pend... $200.00 Medical M
130700000500 Smith, Joe 02/18/2021 11 - Pend... $350.00 Medical M
130900000600 Jones, Brian 03/21/2021 11 - Pend... $250.00 Medical M
     
  Group: G1234   Eff. Date: 01/01/2009   External ID: 9896695   Other Family Members: Yes
   
Other Family Members
Subscriber   Brown, Tom
Daughter   George-Brown, Mary Ann Elizabeth Isabella Penelope
Son   Brown, John
     
Subscriber Info
General
Last Name: Brown
MI: J
Gender: Male
Covered Members: Family
Memo: This member has 4 instances.
First Name: Tom
Title: --
Gender Identity: Male
Status: Active
DOB: 01/01/1972
SSN: 253-45-3450
Marital Status: Married
Original Eff. Date: 01/01/2009
Address Info
Home Address:
Subscriber Home
Address
Home:
12 Northeast New York Industrial Parkway
  Northeast New York Parkway University N
  Northeast New York PW University Apt 101
  NE Brownsboro Place, NY 10001-1101
County: Northeaster New York Country:United States
Phone: (718) 555-1234 Phone:(718) 555-9999 ext. 222
Email: sue.brown@gmail.com      
Work Address:
Work Address 1
Address
Home:
1515 Southeast New York New York Parkway
  Southeast New York New York University S
  Southeast NY NY Univeristy Office #10105
  SE Brownsboro Plan, NY 10001-1101
County: Northeaster New York Country:United States
Phone: (718) 555-9876 Phone:(718) 555-9999 ext. 222
Email: sue.brown@gmail.com      
Mailing Address
Subscriber Home
Address
Home:
12 Northeast New York Industrial Parkway
  Northeast New York Parkway University N
  Northeast New York PW University Apt 101
  NE Brownsboro Place, NY 10001-1101
County: Northeaster New York Country:United States
Phone: (718) 555-1234 Phone:(718) 555-9999 ext. 222
Email: sue.brown@gmail.com      
Work Phone: (999) 999-9999
Cell Phone: (544) 564-5645
Ext: 1234
Applicant Information
Hire Date: 01/01/1998
Conversion Date: 01/01/1999
Status: Active
Processing Status: 1
Employee ID: 1564426453
Signature Date: 01/01/1999
VIP Type: President/CEO
Reason: Pending Verification
Retire Date: --
Received Date: 01/01/2000
Check Payment Options
Claims: One Check per EOB/Claim
EFT Indicator: --
FSA: One FSA Reimbursement per Check/EOB
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