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Name:Mnr Jacob Visser
Initials:JDependant Type:Principal party
Date of Birth:10/08/1953Gender:Male
Membership No.:134123456Dependant No.:00
Plan:Classic Saver
Effective From:01/01/2004
Status:The membership is valid and active
ID No.:7108235012092
Information as at:06/08/2013, 14:44:32Discovery Ref:8187

  • We will only pay a portion of the claim
CodesICD10DescriptionQtyClaimedPay to providerPay to memberMember liableMember not liableComments
0173 S91.0 W45.81First hospital consultation/visit of an average du1771.90369.100.000.00402.80Show
0011 S91.0 W45.81Emergency procedure minute851012.350.000.00101.10911.25Show
0147 S91.0 W45.81For an emergency consultation/visit away from the1635.70359.200.000.00276.50Show
0304 S91.0 W45.81Major debridement of wound, sloughectomy or second11406.00794.600.000.00611.40Show
0010 S91.0 W45.81Local anaesthetic11235.52698.200.000.00537.32Show
0007 S91.0 W45.81a) Use of own monitoring equipment in the rooms:1421.82238.400.000.00183.42Show
0923 0005 S91.0 W45.81Removal of foreign bodies requiring incision: Unde1674.90317.850.000.00357.05Show
2802 S91.0 W45.81Procedures for pain relief: Peripheral nerve block1703.000.000.00396.90306.10Show
0887 S91.0 W45.81Limb cast (excluding after-care) (modifier 0005 no1365.500.000.000.00365.50Show
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RA101A potential authorisation has been found but an extension on this may be required.

Authorization details
Auth. No.TypeDate rangeOther
13812345In Hospital10/07/2013 - 10/07/2013Admitting Dr: O'Hare G D D (PCNS 0112345)
Facility: Rosalind Clinic (PCNS 5812345)

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