Notes

650 - WILLIAMS (3616458226)
652 - ROBERT DRAPER (9188102744)
656 - LESLI BOOKER (4052691893)
657 - DONALD GALLOWAY (9198626927
1226011 - PATRICK GARR (6065104770)
659 - DANIEL HINDS (9188407627)
662 - DEBRA ELLIOTT (9037171783)
1226085 - RICKY ROBERTSON (2563900828
1226203 - MARY HODAPP (9282019526)
668 - ELENA LEVY (2817215927) SKI
669 - ANTONIO DICIENZO (6055093201)
674 - ALVIN BAILEY JR (2703136567)
679 - JACK WARD (6099944050)
1226239 - DEBRA OCONNOR (7244989101
680 - STEPHEN ROEBECK (7579206236) SKI
685 - BEVERLY MAYO (3189908409) SKI
683 - INEZ FRAZIER (9102384019
690 - DON PIROUTEK (6504641887)
689 - WAYNE PETRATUONA (7075101297)
693 - PATRICK BUI (7146000200)
694 - STANLEY GARNER SR (5106775219)
ASHOK MUNGARA (7137717776)


2038959240
Date Requested : 2019-02-25
BB

First Name : DAVID
Middle Name : A
Last Name : ANGESKI
Gender : M
DOB : 1957-09-14
Address 1 : 31 COLUMBIA ST
Address 2 : FL 1
City : ANSONIA
State : CT
Zip : 064012403

Subscriber ID : 8DP9ED6AJ37

Health Benefit Plan Coverage

Medicare Part A
- Active Coverage :
- DeductibleEpisode : $1364
- DeductibleRemaining : $1364
- Co-PaymentEpisode :
- Co-PaymentDay : $341
- Co-PaymentEpisode :
- Co-PaymentDay : $341
- ReserveLifetime :
- ReserveLifetime Remaining :
- ReserveDay : $682

Medicare Part B
- Active Coverage :
- DeductibleCalendar Year : $185
- DeductibleRemaining : $51.43
- Co-InsuranceVisit :

Preferred Provider Organization (PPO)
- Contact Following Entity for Eligibility or Benefit Information :
- Name : AETNA LIFE INSURANCE COMPANY
- Address 1 : 151 Farmington Avenue
- Address 2 :
- City : Hartford
- State : CT
- Zip : 06156
- Contact Info :
8006240756
www.aetnamedicare.com

Insurance Information
- AETNA LIFE INSURANCE COMPANY (Pharmacy)
- AETNA LIFE INSURANCE COMPANY (Health Benefit Plan Coverage)


679 - JACK WARD (6099944050)
1588616353
Date Requested : 2019-02-25
BB

First Name : JACK
Middle Name : A
Last Name : WARD
Gender : M
DOB : 1930-07-04
Address 1 : 1208 FERNANDO LN
Address 2 :
City : LADY LAKE
State : FL
Zip : 321595779

Subscriber ID : 4J22FX0JP21

Health Benefit Plan Coverage

Medicare Part A
- Active Coverage :
- DeductibleEpisode : $1364
- DeductibleRemaining : $1364
- Co-PaymentEpisode :
- Co-PaymentDay : $341
- Co-PaymentEpisode :
- Co-PaymentDay : $341
- ReserveLifetime :
- ReserveLifetime Remaining :
- ReserveDay : $682

Medicare Part B
- Active Coverage :
- DeductibleCalendar Year : $185
- DeductibleRemaining : $185
- Co-InsuranceVisit :

Insurance Information
- UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY (Pharmacy)


7146582540
sb
Date Requested : 2019-02-25

First Name : DAWNE
Middle Name : L
Last Name : BURT
Gender : F
DOB : 1946-12-22
Address 1 : 16080 TORTOLA CIR
Address 2 :
City : HUNTINGTN BCH
State : CA
Zip : 926492042

Subscriber ID : 557701065A

Health Benefit Plan Coverage

Medicare Part A
- Active Coverage :
- DeductibleEpisode : $1364
- DeductibleRemaining : $1364
- Co-PaymentEpisode :
- Co-PaymentDay : $341
- Co-PaymentEpisode :
- Co-PaymentDay : $341
- ReserveLifetime :
- ReserveLifetime Remaining :
- ReserveDay : $682

Medicare Part B
- Active Coverage :
- DeductibleCalendar Year : $185
- DeductibleRemaining : $64.02
- Co-InsuranceVisit :

1227050 - CALVIN JACKSON JR III (9129781691)
BB sb kb
1104874031
Date Requested : 2019-02-25

First Name : CALVIN
Middle Name :
Last Name : JACKSON JR III
Gender : M
DOB : 1974-08-08
Address 1 : 807 BURNT POTTERY LN
Address 2 :
City : STATESBORO
State : GA
Zip : 304616792

Subscriber ID : 255236663A

Health Benefit Plan Coverage

Medicare Part A
- Active Coverage :
- DeductibleEpisode : $1364
- DeductibleRemaining : $1364
- Co-PaymentEpisode :
- Co-PaymentDay : $341
- Co-PaymentEpisode :
- Co-PaymentDay : $341
- ReserveLifetime :
- ReserveLifetime Remaining :
- ReserveDay : $682

Medicare Part B
- Active Coverage :
- DeductibleCalendar Year : $185
- DeductibleRemaining :
- Co-InsuranceVisit :

Insurance Information
- MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY (Pharmacy)


716 - JAMES SCARBROUGH (9048887622)