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CEDAR GROVEHEALTH PLANMember •••• 2048
Statement: October 1

Explanation of benefits

This is not a bill. Please keep for your records.

Service date: September 18
Provider: Cedar Grove Clinic
Service: Office visit
Claim status: Processed

Summary of services received. This statement is for your records and is not a request for payment.

Member services · Benefits statementPage 1 of 1

Lookover explains

This is a record, not a bill.

Your health plan has processed a claim for an office visit at Cedar Grove Clinic on September 18. This statement is for your records and does not ask for payment. If you don’t recognize the visit, check with your health plan using contact details you trust.

Nothing to pay from this letter

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