{% load static %}
| Claim ID | Service Date | Service Type | Provider | Amount | Approved | Patient Resp. | Status | Actions |
|---|---|---|---|---|---|---|---|---|
|
{{ claim.claim_id }}
Filed: {{ claim.claim_date }}
|
{{ claim.service_date }}
{% if claim.diagnosis_code %}
{{ claim.diagnosis_code }}
{% endif %}
|
{{ claim.service_type }}
{% if claim.procedure_code %}
{{ claim.procedure_code }}
{% endif %}
|
{{ claim.provider }}
|
ê{{ claim.claim_amount|floatformat:'2g' }}
|
{% if claim.approved_amount > 0 %}
ê{{ claim.approved_amount|floatformat:'2g' }}
{% else %}
-
{% endif %}
|
{% if claim.patient_responsibility > 0 %}
ê{{ claim.patient_responsibility|floatformat:'2g' }}
{% else %}
-
{% endif %}
|
{{ claim.status|title }}
{% if claim.processed_date %}
{{ claim.processed_date }} {% endif %} |
{% if claim.status == 'denied' %}
{% endif %}
{% if claim.status == 'paid' %}
{% endif %}
|
No insurance claims found for this policy.
Total patient responsibility for all claims: ê{{ summary.total_patient_responsibility|floatformat:'2g' }}
This includes copays, deductibles, and non-covered services.