Values from records
1render unknown
The record values this file is made from: the ones its text names with {{record.field}}, and the fields its template reads. A value here is in the file's source; whether it is readable depends on the look.
The values at render time were not recorded: the file was rendered before files/rendered.json existed. Rendering it again records them.
Planted
only_in_file Hard file, a field cut off: the EOB for Eli's 2023 ER visit was photographed with its right edge out of frame, and the right edge is the "amount you may owe" column. The truth is $638.00 in all ($250 copay paid at the visit plus $388 coinsurance billed later). Neither figure is anywhere in the account; only the $250 copay receipt is. The right answer is that it cannot be read, with a request for a better copy.
attachments.yaml
record: doc-er-eob
template: document
style: statement
look: scan
crop: right
org:
name: Corvane Health Plan
lines:
- PO Box 30744
- Columbus, OH 43230
phone: '8005550173'
web: corvane.example
color: '#1f5f8b'
title: Explanation of Benefits
body: '**This is not a bill.** It shows how a claim was processed. Your provider may bill you for the
amount you owe.
**Subscriber:** Marcus D Adeyemi
**Member ID:** {{insurance-card-family.identification_number}}
**Patient:** Eli J Adeyemi (dependent)
**Claim number:** 23-2530-0091847
**Provider:** Scioto Riverside Hospital, Emergency Department (in network)
**Date of service:** 09/09/2023
**Processed:** 10/17/2023
| Service | Billed | Plan paid | Amount you may owe |
|---|---|---|---|
| Emergency room visit, level 4 | $1,842.00 | $902.40 | $475.60 |
| Physician, emergency medicine | $486.00 | $214.20 | $94.80 |
| Medications given in the department | $187.50 | $62.10 | $41.40 |
| Observation, 3 hours | $412.00 | $171.80 | $26.20 |
| **Total** | **$2,927.50** | **$1,350.50** | **$638.00** |
## How your share was worked out
| | |
|---|---|
| Emergency room copay | $250.00 |
| Deductible applied | $0.00 |
| Coinsurance | $388.00 |
| **Total you may owe the provider** | **$638.00** |
| Paid at the visit, as reported by the provider | $250.00 |
The provider has agreed to accept the plan''s allowed amount. You do not owe the difference between
the billed amount and the allowed amount.
Questions? Call Member Services at the number on your ID card. You may appeal this decision within 180
days.
'
