Health Plan Claims
These claims have been provided by your health plan to help you pay the amount you owe from you HSA. Before making a payment, review the claim amount listed below to make sure it matches the amount owed on your provider's bill. If you have any questions, please contact your provider or health plan for assistance.
| Claim ID | Service Date | Provider/Vendor | Recipient | Claim Amount | Status | |
|---|---|---|---|---|---|---|
| 123456789 | 12/01/2016 | Dr. Smith | Lee Smith | $50.00 | Open | PayClose |
| 234567890 | 07/03/2016 | Walgreens | Lee Smith | $75.00 | Open | PayClose |
| 345678901 | 04/15/2016 | Children’s Hospital | Paul Smith | $100.00 | Open | PayClose |
| 324324111 | 09/15/2016 | Minute Clinic | Paula Smith | $45.00 | Paid to Myself | |
| 234234234 | 02/15/2015 | Dr. Jones | Lee Smith | $175.00 | Closed | |
| 234234234 | 02/01/2015 | Dr. Kildare | Lee Smith | $25.00 | Paid to Provider |