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    Ketut Stitha Prajna Sugi Hari - 1977138

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    Rojik Gama
    Ketut Stitha Prajna Sugi Hari received inpatient treatment at RSU Kertha Usada Singaraja from June 15-18, 2016. The total claim amount was 8,786,700 which was fully approved and paid by Prudential Hospital & Surgical for services including various medical treatments, specialist doctor fees, general practitioner fees, room charges, and type 1 surgery. All charges were covered with no excess amount due.

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    Ketut Stitha Prajna Sugi Hari - 1977138

    Uploaded by

    Rojik Gama
    25 views1 page
    Ketut Stitha Prajna Sugi Hari received inpatient treatment at RSU Kertha Usada Singaraja from June 15-18, 2016. The total claim amount was 8,786,700 which was fully approved and paid by Prudential Hospital & Surgical for services including various medical treatments, specialist doctor fees, general practitioner fees, room charges, and type 1 surgery. All charges were covered with no excess amount due.

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    Ketut Stitha Prajna Sugi Hari_1977138

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    Ketut Stitha Prajna Sugi Hari received inpatient treatment at RSU Kertha Usada Singaraja from June 15-18, 2016. The total claim amount was 8,786,700 which was fully approved and paid by Prudential Hospital & Surgical for services including various medical treatments, specialist doctor fees, general practitioner fees, room charges, and type 1 surgery. All charges were covered with no excess amount due.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    25 views1 page

    Ketut Stitha Prajna Sugi Hari - 1977138

    Uploaded by

    Rojik Gama
    Ketut Stitha Prajna Sugi Hari received inpatient treatment at RSU Kertha Usada Singaraja from June 15-18, 2016. The total claim amount was 8,786,700 which was fully approved and paid by Prudential Hospital & Surgical for services including various medical treatments, specialist doctor fees, general practitioner fees, room charges, and type 1 surgery. All charges were covered with no excess amount due.

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    © All Rights Reserved
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    of 1

    Claim Details

    Client

    PRUhospital & surgical

    Group

    Prudential Individual

    Patient

    KETUT STITHA PRAJNA SUGI HARI

    Member No.

    1977138 A

    Client No.

    Claim Ref.

    267572 / 3652436 / 1

    Provider

    RSU KERTHA USADA Singaraja

    Claim Type

    Inpatient

    Date of Service

    15-Jun-2016 - 18-Jun-2016

    Open

    Item
    Biaya Aneka Perawatan
    Biaya Dokter Spesialis
    Biaya Dokter Umum
    Biaya Kamar
    Operasi Type I

    Polis No. : 18527203


    Charge

    Approved

    Benefit Paid

    Excess Charge

    2,596,200

    2,596,200

    2,596,200

    390,000

    390,000

    390,000

    80,000

    80,000

    80,000

    900,000

    900,000

    900,000

    4,820,500

    4,820,500

    4,820,500

    Sub Total :

    8,786,700

    8,786,700

    8,786,700

    GRAND TOTAL :

    8,786,700

    8,786,700

    8,786,700

    Report Printed: 18-Jun-2016 12:43:19


    This Report is provided by PT. JLT Gesa, your Plan Administrator & Risk Manager.

    Page 1 of 1

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