A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | |
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1 | 922072658 | Patient Name | HN | Insurance Company (ชื่อบริษัทประกัน) | Your Department (แผนก) | Procedure (หัตถการ) | Estimate cost | Date of procedure | Request by (ชื่อผู้ยื่น) | Result (Insurance staff only) | GOP request sent date | Date of last follow up | Informed Patient? (Y/N) | Call or E-mail | | |||||||||||
2 | ประทับเวลา | Patient Name | HN | Insurance Company (ชื่อบริษัทประกัน) | Your Department (แผนก) | Procedure (หัตถการ) | Estimated cost (ราคาประเมิน) | Date of Service (วันนัดทำหัตถการ) | Request by (ชื่อผู้ยื่น) | |||||||||||||||||
3 | 22/11/2022, 18:26:05 | MR. GREGORY BUATHIER | 0922073868 | April | Spine | Laminectomy +fusion + PRE-OP 15,000-20,000+ atk 350 | 610,000-660,000 baht | planning pre-op test (23/11), and surgery (24/11) // postponed until GOP | Chaowan | cover but only 50% of estimate cost/ Need date for official GOP/ pt will call back to Spine after 1 month / Follow date of service | 22/11/2022 | 9/2/2023 | yes | call | ||||||||||||
4 | 12/4/2022, 10:55:37 | MR. MANFRED MUENZKER | 09-16-013847 | Euro-center | surgery | excision lipoma at chest wall | 44,000-50,000 | no schedule | cover but need date for GOP- follow date of appointment // pt will call us back to make appointment, now he is in Koh Samui | 13/04/2022 | 05/05/2022 | |||||||||||||||
5 | 18/4/2022, 12:40:02 | MS. CHAO DARASAK NA CHAMPASSAK | 0908016153 | OTHERS | eye department | phaco with IOLleft eye | 75,000 including with pre-op malakoff humanis HA164003S | 15/5/2565 | sopapan | Patient said, she will contact with her insurance by herself, once she receive response/GOP from insurance, she would inform us | 03/05/2022 | yes | call and asked for insuance card | |||||||||||||
6 | 28/6/2022, 13:32:19 | MRS. THANYAPORN JAIPRIAW | 09-09-015596 | Euro-center | shoulder and joint | MRI Lt shoulder | 15,000 | 17/07/2022, update infos, wait for GOP, might be on 19/07/2022 | benjawan | On process - Follow on 20/09/2022 with clinic if patient still needs to do procedure | 28/06/2022 | 17/07/2022 | ||||||||||||||
7 | 5/7/2022, 15:23:13 | MR. CARLOS DAVID GRANON | 0911009138 | OTHERS | Surgery | Colonoscopy | 25,000 | wait GOP | Chayanit RN | ON process - insurance need to contact patient (patient cancel and will be back on sept) | 05/07/2022 | 15/07/2022 | ||||||||||||||
8 | 5/7/2022, 15:24:15 | MR. CARLOS DAVID GRANON | 0911009138 | OTHERS | Surgery | Medical clearance before Colonoscopy | 3,000 | wait GOP | Chayanit RN | on process - insurance need to contact patient (patient cancel and will be back on sept) | 05/07/2022 | 15/07/2022 | ||||||||||||||
9 | 22/9/2022, 17:53:13 | MR. CHRISTIAN MARTENA | 0911003282 | Luma | surgery | Excision cyst at Lt. ear + Lap. repair hernia + medical clearance+covid test | 300,000 - 340,000 | 25/01/2023 | CHANATDA RN | Cover | 22/09/2022 | 23/01/2023 | yes | call | ||||||||||||
10 | 3/11/2022, 18:03:57 | นางสาว ดลิน คงเสรี / Dalin Kongseri | 0922062960 | Aetna | allergy clinic | immunotherapy mite+jone injection allergy | 45,860 | 10/11/2022 | suteera Rn | On process | 04/11/2022 | 23/02/2023 | ||||||||||||||
11 | 8/11/2022, 12:44:01 | MRS. ANNE MARTIN-PALLIERES | 0908009581 | Cigna | Rehab | 1.PT /2.ESWT each 5 sessions | 1.PT = 2,650 /2.ESWT = 4,850 Baht/session | 09/11/2022 | Wantana | On process // Follow insurnace questions with Rehab | 09/11/2022 | 23/2/2023 | ||||||||||||||
12 | 17/11/2022, 17:04:06 | MS.ANCHALEE JUNPHUNGPHRKIAT | 0918013384 | April | CARDIO | 2C1U and Blood test | 22000 | 29/03/2023 | วริชยา จันทร์ดิษฐ | Approved, Follow official GOP | 18/11/2022 | 16/3/2023 | Yes | call | ||||||||||||
13 | 22/11/2022, 16:15:54 | MR.CHARLES R. DITTMEIER | 09-04-030845 | Aetna | Surgery department | CT whole abdomen(plus delay KUB),CT chest low dose | 46,850 baht | 08/05/2023 | มัลวิภา | SEND 1 MONTH BEFORE (APRIL 2023) | ||||||||||||||||
14 | 27/11/2022, 13:36:41 | MR. DANIEL KIM | 0913004300 | OTHERS | rehab | PT Programs , Occupational Therapy | PT Programs = 2,050 baht , Occupational Therapy = 1,850 baht | รอประกันตอบกลับ | อาภาพร | On process | 27/11/2022 | 31/12/2022 | ||||||||||||||
15 | 2/12/2022, 15:58:29 | MRS. NATHIMA ARNBACK | 09-14-035220 | Luma | GI | gastro-colonoscopy | 49000 | 08/01/23 | Pornpen | Cover | 02/12/2022 | 03/01/2023 | yes | |||||||||||||
16 | 11/12/2022, 9:25:35 | M.MANITA ANANRATTANACHOTE | 0916028866 | Henner | ENT clinic | Endo powered turbinoplasty + medical claearance | 240,000 - 310,000 Baht + 10,000 | March 2023 | Chonticha, RN | Resend again in the middle of FEB since plan procedure is in MAR 2023 | 11/12/2022 | 15/2/2023 | ||||||||||||||
17 | 12/12/2022, 16:00:23 | DR. JACQUELINE PARISI | 09-13-004126 | OTHERS | rehab | PT Programs | 900 | ครั้งที่1 วันที่ 12/12/2022 | อาภาพร | done ALREADY | 12/12/2022 | 15/12/2022 | yes | |||||||||||||
18 | 14/12/2022, 9:16:42 | MR. ALAIN MERCIER | 0916038469 | GMC (Henner) | EYE CLINIC | Phacoemultifacation with IOL Left eye | 65,000 | 13/1/2023 | Ketsaraphon RN. | Cover | 14/12/2022 | 10/1/2023 | yes | |||||||||||||
19 | 15/12/2022, 9:51:24 | MR. JAN HANSEN | 09-18-008244 | Aetna | skin | shave biopsy with CO2 laser | 26,550 | 5/01/2023 >>moved to 12/01/2023 | kanyapak | NOT COVER; Pt needs to consult and discuss with dr for treatment options as doctor will not write answer anymore NOT COVER; | 15/12/2022 | 4/1/2023 | yes | |||||||||||||
20 | 15/12/2022, 12:07:04 | MR. NICO DAMIANO KHAGHANI | 09-22-068812 | OTHERS | rehab | ESWT , PT Programs | ESWT = 3,600 baht, PT Programs=2,700 baht | รอประกันตอบกลับ | อาภาพร | Insurance said, patient will pay and cliam | 16/12/2022 | 30/12/2022 | ||||||||||||||
21 | 17/12/2022, 16:04:04 | MR. WOLFGANG TROST | 0915035632 | OTHERS | opd med | chemo therapy | 158,500 bath | 16/01/2022 | suteera Rn | Cover | 17/12/2022 | 15/1/2022 | yes | |||||||||||||
22 | 19/12/2022, 13:42:07 | MR. MICHAEL HAUGEN | 0922062591 | Cigna | rehab | ESWT , Dry needling ,PT Programs | ESWT= 5,300 baht , Dry needling = 3,600 baht ,PT Programs = 3,000 baht | รอประกันตอบกลับ | อาภาพร | COVER. GOP PT ONLY | 19/12/2022 | 28/12/2022 | yes | call | ||||||||||||
23 | 20/12/2022, 10:57:32 | MR. THIERRY CRUZ | 0909016960 | OTHERS | surgery | Colonoscopy with Staple hemorrhoidectomy + medical clearance | 110,000 - 140,000 + 3,000 | waiting GOP | CHANATDA RN | on process | 20/12/2022 | 15/1/2023 | ||||||||||||||
24 | 22/12/2022, 10:03:21 | MR. MARK FRANCIS | 0920000527 | Cigna | SPINE | Laminectomy with fusion L3-5 + Medical clearance 20,000 THB + ATK 350 THB | 580,000 - 630,000 | 12/01/2023 (Plan) | YURAIPAN N. | Cover | 22/12/2022 | 14/1/2023 | yes | call | ||||||||||||
25 | 27/12/2022, 17:38:26 | MS. HARUKA SATOH | 0918028490 | April | Rehab | 1.ESWT/ 2.PT each 6 sessions | 1.ESWT 5,300 / 2.PT = 2,300 Baht/session | Started 1st session of PT 27/12/2022 | Wantana | Cover | 28/12/2022 | 13/1/2023 | yes | |||||||||||||
26 | 29/12/2022, 16:35:58 | Mr.BENJAMIN RICH COOLING | 0921025648 | OTHERS | CARDIO | LAB,EKG,ECHO,EST | 14,140 | 26/02/2023 | พรปวีร์ | Cover | 29/01/2023 | yes | call (no answer) , sent email | |||||||||||||
27 | 29/12/2022, 17:48:47 | MS.ARA KIM | 0922072525 | Cigna | GYN | Diagnosis laparoscopic | 58,500 | plan 5 Jan 2023 | 530225 | Cover | 30/12/2022 | yes | call (no answer) | |||||||||||||
28 | 30/12/2022, 10:52:04 | MS. REBECCA EXTON | 0921023979 | OTHERS | Surgery Department | medical clearance | 4,350-5,350 บาท | 3/01/2023 | มัลวิภา | Cover | 30/12/2022 | yes | ||||||||||||||
29 | 30/12/2022, 12:01:40 | MR. GEORGE ELISSEOU | 0922068115 | United Healthcare (UHC) | Spine | MRI Planning Cut C +Xray C spine | 22,950 baht | wait forGOP | Chaowan | Cover | 30/12/2022 | yes | called no answer, sent email | |||||||||||||
30 | 1/1/2023, 9:35:27 | MR. JAMES ROOP | 0919027634 | Cigna | GI | colono deep | 39000 | 6/1/2023 | สุชาดา | Cover | 01/01/2023 | 04/01/2023 | yes | |||||||||||||
31 | 1/1/2023, 12:40:53 | MR. KURT JAECKEL | 0915026168 | Allianz Worlwide Care | Surgery Department | Ultrasound droppler vein bilateral | 12,000 | 7/01/2023 | มัลวิภา | Cover | 02/01/2023 | yes | ||||||||||||||
32 | 2/1/2023, 11:13:27 | MRS.ARUNEE RUJIVANARON | 0901019260 | Aviva | cardio | blood test / Echocardiogram /Ultrasound carotid | 17200 | 27/3/23 | สุรัสสา พรมเสาร์ | Cover | 03/01/2023 | yes | ||||||||||||||
33 | 2/1/2023, 11:55:24 | MS. YU-LUN HONG | 09-14-008363 | HSC | spine | MRI Lumbar spine +x-ray LS spine AP/Lat F/E | 18800 | wait for GOP | tanwalai | Cover | 02/01/2023 | yes | call | |||||||||||||
34 | 3/1/2023, 10:33:33 | MS. SIRITHIP TEMRUDEESIN | 0910006851 | Aetna | Rehab | 1.PT 6 sessions/ 2.ESWT 5 sessions/ 3.Dry needling 5 sessions | 1.PT = 2,300 / 2.ESWT 3,900 / 3.Dry needling = 3,600 Baht/session | 6/01/2023 for PT | Wantana | Cover | 03/01/2023 | yes | call | |||||||||||||
35 | 3/1/2023, 15:44:43 | MS. ANCHALEE JUNPHUNGPHRAKIAT | 09-18-013384 | April | rehab | ESWT , PT programs , US injections | ESWT = 10,150 baht , PT programs = 3,600 baht , US injections = 10,950 baht | รอประกันตอบกลับ | อาภาพร | Cover | 03/01/2023 | 04/01/2022 | yes | |||||||||||||
36 | 3/1/2023, 15:49:51 | FARZONA JALILOVA | TMP132264 | Cigna | check up | young active | 12900 | 14/01/2023 | Phachararin K. | Cover | 03/01/2023 | |||||||||||||||
37 | 3/1/2023, 17:49:42 | MR. EDUARDO DANIEL ROMAN | 0922072304 | GMC (Henner) | Surgery Department | Laparoscopic Cholecystectomy | 180,000 baht | 19/01/2023 | มัลวิภา | Cover | 04/01/2023 | 06/01/2023 | yes | call bit no answer | ||||||||||||
38 | 3/1/2023, 18:02:34 | MR.EDUARDO DANIEL ROMAN+ | 09-22-072304 | GMC (Henner) | Surgery Department | Medical clearance | 3,350 baht | 17/01/23 | มัลวิภา | Cover | 04/01/2023 | |||||||||||||||
39 | 3/1/2023, 18:06:37 | MRS. NITTAYA LERTTRILUCK | 0903012271 | Cigna | Surgery | CT KUB +/- Contrast | 21000 | 15/1/2023 | Muttika RN. | Cover | 04/01/2023 | yes | call | |||||||||||||
40 | 4/1/2023, 13:53:27 | MS. YU-LUN HONG | 0914008363 | OTHERS | SPINE CENTRE | Discectomy L5/S1 + Medical Clearance 20,000 THB + ATK 350 THB | 330,000-380,000 THB | Wait for GOP | YURAIPAN N. | Cover | 04/01/2023 | yes | call | |||||||||||||
41 | 4/1/2023, 14:01:47 | MR. PAOLO TAGLIARETTI | 0920017412 | OTHERS | Spine | MRI planning Cut L s spine | 21,000 baht | 6/01/2023 | Chaowan | Cover | 04/01/2023 | 06/01/2023 | yes | |||||||||||||
42 | 4/1/2023, 14:49:59 | MR. PAOLO ANGELO TAGLIARETTI | 09-20-017412 | OTHERS | rehab | PT Programs | 2,050 | ครั้งที่ 1 วันที่ 4/1/2023 Pt.Dep.ค่าใช้จ่าย | อาภาพร | Cover | 04/01/2023 | 06/01/2023 | yes | pt was copied in email | ||||||||||||
43 | 4/1/2023, 16:15:46 | ANUSORN ROJANASAKDAKUL | 09-18-028632 | Aetna | heart | FNA Thyroid | 12000 | 13/01/23 | วรินธร | Cover | 04/01/2023 | yes | call | |||||||||||||
44 | 4/1/2023, 16:24:14 | MS.ELIZABETH ALICE DIPPLE | 09-23-000177 | AXA PPP (InterPartner) | OPD MED | 0 | 6500 THB | 11/01/2023 | KULISARA | DO PROCEDURE BEFORE APPROVAL | 04/01/2023 | 11/01/2023 | ||||||||||||||
45 | 4/1/2023, 18:24:59 | Mr. David Wise | 09-23-000216 | OTHERS (International SOS) | S&J | MRI | THB 16,800 | 05/01/2023 | Agnes c/o | Cover | 04/01/2023 | |||||||||||||||
46 | 4/1/2023, 18:42:16 | MR. CHRISTOPHER PARDY | 0914010589 | Cigna | opd med | Ultrasound Upper Abdomen.+Ultrasound Carotid Artery | 129000 | 11/01/2023 | suteera Rn | Cover | 05/01/2023 | yes | sent to info | |||||||||||||
47 | 5/1/2023, 13:26:03 | MS. SARA WILLIS | 09-22-076653 | Aviva | rehab | 12/1/2023 | Dry Needling , ESWT , Physical Therapy | Dry Needling = 4,100 baht , ESWT =5,300 baht , Physical Therapy = 2,600 baht | อาภาพร | Cover | 05/01/2023 | yes | call | |||||||||||||
48 | 5/1/2023, 18:28:28 | MR. JONATHAN TSE | 0922074799 | OTHERS | surgery | CT lower abdomen with rectal contrast | 23000 | 12/01/23 | nisachon | Cover | 06/01/2023 | 07/01/2023 | ||||||||||||||
49 | 6/1/2023, 13:56:41 | MR. UWE NEIMAN | 0903009911 | OTHERS | surgery department | Rt. minithoracotomy with wedge RLL + LN dissection | 710000 please cc email pt when sent pre authorize | 15-20/01/23 >> plan admit on 18/01/2023 | nisachon | DO PROCEDURE BEFORE APPROVAL | 06/01/2023 | 15/01/2023 | ||||||||||||||
50 | 6/1/2023, 14:13:21 | MR. CARLOS HERNANDO ARROYAS | 09-22-073358 | OTHERS | spine clinic | MRI + x-ray lumbar spine | 18,800 | 09/01/2023 | Sumiltra RN | Cover | 06/01/2023 | 07/01/2023 | yes | |||||||||||||
51 | 6/1/2023, 16:51:10 | MS. RODJANART BANYATANANUSARD | 0908007575 | Aviva | Rehab | 1.ESWT/ 2. PT each 6 sessions | 1.ESWT = 6,650 / 2. PT = 2,920 baht/session | Started 1st session of ESWT on 5/01/2023 and PT on 06/01/2023 | Wantana | DO PROCEDURE BEFORE APPROVAL | 07/01/2023 | |||||||||||||||
52 | 6/1/2023, 17:58:02 | MR. ANTONIO DE OLIVEIRA CARVALHEIRA CORREIA | 09-23-000192 | MSH China | shoulder and joint | Arthroscopy MM reduction and repair | 450,000-520,000 baht + pre op 15,000-20,000 baht | wait GOP | benjawan | Cover | 07/01/2023 | 11/01/2023 | yes | call | ||||||||||||
53 | 7/1/2023, 11:38:46 | MS. NAOKO NAKAGAWA | 09-18-012228 | Cigna | skin | co2 laser | 11450 | 14/01/2023 | Natcha | Cover | 08/01/2023 | 10/01/2023 | yes | |||||||||||||
54 | 7/1/2023, 12:09:49 | MRS. ELENA DEL FABBRO | 0919010788 | Cigna | OBG | vaginal delivery +/- epidural block, cesarean section as indicated | NDP 89000/ NDP+PL 108000/ NDP change to C/S 139,000/ NDP+Painless change to C/S 155000 | EDC 27/01/2023 | Kirana Vasanachoti | Cover | 09/01/2023 | yes | call | |||||||||||||
55 | 7/1/2023, 14:01:56 | MS. EBRU GURELI | 0918015626 | Cigna | shoulder and joint | MRI Rt knee +injection | 20,850 baht | wait GOP | Niporn | Cover | 08/01/2023 | 12/01/2023 | ||||||||||||||
56 | 7/1/2023, 16:33:48 | MR. ROGER JOSEPH OGDEN | 0906026214 | Allianz Worlwide Care | Surgery | CT brain non contrast | 9,500 | 28/1/23 | Chayanit RN | Cover | 09/01/2023 | 10/09/2022 | yes | |||||||||||||
57 | 8/1/2023, 15:23:23 | MR. ANKUR GUPTA | 0922073651 | Aetna HK | spine | MRI Planning Cut C- spine | 22,850 baht | wait GOP | Niporn | Cover | 08/01/2023 | yes | ||||||||||||||
58 | 8/1/2023, 16:06:12 | MR. ANKUR GUPTA | 09-22-073651 | Aetna HK | rehab | PT Programs | 3,070 | 13/1/2023 | อาภาพร | Cover | 09/01/2023 | yes | ||||||||||||||
59 | 9/1/2023, 10:27:07 | MR. MICHAEL ANTHONY HAUGEN | 09-22-062591 | Cigna | spine | MRI C spine | 15000 | ยังไม่ระบุวัน | รัชฎาภรณ์ | Cover | 09/01/2023 | 10/09/2022 | yes | |||||||||||||
60 | 9/1/2023, 10:57:33 | MR. MICHAEL ANTHONY HAUGEN | 09-22-062591 | Cigna | rehab | PT Programs | 3,000 | 9/1/2023 | อาภาพร | Cover | 09/01/2023 | 10/09/2022 | yes | |||||||||||||
61 | 9/1/2023, 13:11:58 | MR. CARLOS HERNANDO ARROYAS | 0922073358 | OTHERS | rehab | PT Programs ,HPLT ,PMS | PT Programs=2,050 baht ,HPLT =3,300 baht ,PMS = 3,350 baht | 12/1/2023 | อาภาพร | Cover | 09/01/2023 | 13/01/2023 | yes | |||||||||||||
62 | 9/1/2023, 16:39:54 | MR. JEROME PAUL MARSHALL | 0912030369 | Aviva | Surgery | Laparoscopic repair hernia | 270,000-310,000 | 20/2/2023 | Chayanit RN | Cover | 10/01/2023 | 13/01/2023 | yes | |||||||||||||
63 | 9/1/2023, 17:19:53 | MR. JEROME PAUL MARSHALL | 0912030369 | Aviva | Surgery | Medical clearance | 3,350 | with GOP | Chayanit RN | Cover | 10/01/2023 | 13/01/2023 | yes | |||||||||||||
64 | 9/1/2023, 18:01:53 | MS. RIHO SAKUMA | 09-23-000609 | OTHERS | skin | cryogen+kenacort inj.+shave with co2 | 19,850 | ขอเร็วที่สุดค่ะ | พิมผกา ชิณวงษ์ | Cover | 11/1/2023 | 13/01/2023 | yes | patient received information from EAJ | ||||||||||||
65 | 9/1/2023, 18:48:33 | MR. GEORGII NIKOLAENKO | 09-21-026916 | Cigna | sjc | MRI Lt.wrist | 15000 | 15/1/23 | รัชฎาภรณ์ | Cover | 10/01/2023 | 11/01/2023 | yes | |||||||||||||
66 | 10/1/2023, 8:38:23 | MR. REMINGTON LOW | 0917031238 | Cigna | gi clinic | EGD+COLONOSCOPY >> change to Colonoscopy | 39,000 >> THB 25,000 | 20/04/2023 | ฉัตรฤดี RN | Cover | 10/01/2023 | 13/01/2023 | yes | |||||||||||||
67 | 10/1/2023, 9:49:21 | MR. BRYAN MARCO | 0914034149 | Aetna | Surgery | Med clearance | 16,440 - 17,440 | Waiting GOP from insurance | Muttika RN. | Cover | 10/01/2023 | 15/01/2023 | yes | |||||||||||||
68 | 10/1/2023, 9:50:33 | MR. BRYAN MARCO | 0914034149 | Aetna | Surgery | Robotic assist radical prostatectomy | 810,000 - 870,000 | 30/01/2023 | Muttika RN. | Cover | 10/01/2023 | 15/01/2023 | yes | |||||||||||||
69 | 10/1/2023, 10:09:59 | MR. PUTU OKA DIPUTRA | 09-15-005046 | United Healthcare (UHC) | shoulder and joint | MRI Rt shoulder | 15000 | 13/1/23 | benjawan | Cover | 10/01/2023 | yes | sent | |||||||||||||
70 | 10/1/2023, 11:48:50 | MRS. DIANE KEANEY | 0916003867 | AXA PPP | rehab | ESWT ,PMS ,PT Programs | ESWT =7,550 baht, PMS = 3,350 baht ,PT Programs = 4,400 baht | 16/1/2023 | อาภาพร | Cover | 10/01/2023 | 15/01/2023 | yes | |||||||||||||
71 | 10/1/2023, 15:33:29 | MRS. SOPHIE LEFEBVRE | 09-15-013545 | MSH China | rehab | PMS | 3,350 | รอประกันตอบกลับ | อาภาพร | Cover | 10/01/2023 | 14/1/2023 | yes | |||||||||||||
72 | 10/1/2023, 15:37:40 | MR. PAOLO TAGLIARETTI | 0920017412 | OTHERS | rehab | PT Programs | 3,850 | 15/1/2023 | อาภาพร | Cover | 10/01/2023 | 15/01/2023 | yes | |||||||||||||
73 | 10/1/2023, 17:32:38 | MS. EWE SUAN LEONG | 09-10-007510 | Bupa | spine | MRI L-S spine | 17,350 baht | 16/1/2023 | ยูไรพรรณ์ | Cover | 10/01/2023 | 11/01/2023 | yes | |||||||||||||
74 | 11/1/2023, 12:05:08 | MS. KITTIMA THANAJVANICH | 09-99-006753 | Aviva | rehab | PT Programs | 2,750 | ครั้งที่1;yomuj11/1/2023 | อาภาพร | Cover | 11/01/2023 | 14/01/2023 | yes | call, email | ||||||||||||
75 | 11/1/2023, 14:49:25 | JOSHUA OOSTINDIEN | 0919028997 | Cigna | checkup | 16/01/2023 | 12900 | young active | Nuttanee Pinjai | Cover | 11/01/2023 | 15/01/2023 | ||||||||||||||
76 | 11/1/2023, 16:35:34 | MRS. LILY FLOR MORALES OOSTINDIEN | 09-19-019541 | Cigna | Cardio | FNA Thyroid | 9,700 -11,700 | 16/Jan /2023 | Naphatsara | Cover | 13/01/2023 | 14/01/2023 | yes | |||||||||||||
77 | 11/1/2023, 17:59:22 | MR. KEVIN LECLERC | 0906000168 | GMC (Henner) | OPD MED | SLEEP TEST | 29,000 BATH | 18/01/2023 | SUTEERA RN | Not Cover | 13/01/2023 | 15/01/2023 | yes | |||||||||||||
78 | 12/1/2023, 14:00:28 | MR.MICHAEL SCHLUETER | 0917014174 | Metlife | Cardio | Check up Golden Active Male+U/S Carotid Artery,BMD Hip+Spine | 41,000 B. | 17 Jan 2023 | Pornpawee | Cover | 12/01/2023 | 13/01/2023 | yes | |||||||||||||
79 | MS. JODIE FAYE PRICE | 09-13-013551 | MSH China | Physical Therapy | PT 6 sessions | 2,300 Baht/session | 1st = 12/01/2023 | Ying | Cover | 13/01/2023 | 17/01/2023 | yes | call | |||||||||||||
80 | 12/1/2023, 17:34:39 | MS.VIPUNJIT KETUNUTI | 09-01-004498 | Cigna | MEDICINE UNIT | SLEEP TEST | 29000 THB | 16/01/2023 | KULISARA | Cover | 13/01/2023 | 15/01/2023 | yes | |||||||||||||
81 | 12/1/2023, 18:32:23 | MRS.LILY FLOR OOSTINDIEN | 09-19-019541 | Cigna | checkup | golden active add Ferritin,CA19-9pancreas,Ca125 Ovary,CA15-3 breast,Homocysteine | golden active =37900 Bath + Ferritin=1260bath+ ,CA19-9pancreas =1680 bath +Ca125 Ovary1680 bath +CA15-3 breast =1680 bath +Homocysteine=2310 bath tatal =46510 บาท | 15/01/2022 | Kanyapat RN | Cover | 13/01/2023 | 18/01/2023 | yes | email / call (no answer) | ||||||||||||
82 | 13/1/2023, 8:49:50 | MR. MANOJ ARORA | 0914004307 | MSH China | Breast center | CT simulation + Radiation Therapy | 469,400 | 14/01/23 | CHANATDA RN | Cover | 13/01/2023 | yes | pt received GOP from insurance as cc email | |||||||||||||
83 | 13/1/2023, 9:46:24 | MR. ALTEMIR WOLLMANN | 09-07-020644 | Cigna | skin | excision biopsy โทรแจ้งสิทธิ์และส่งmailให้คนไข้นะคะ ในระบบถูกต้อง | 24,950 | 10/02/2023 | kanyapak | Cover | 13/01/2023 | yes | ||||||||||||||
84 | 13/1/2023, 12:32:50 | MR. MICHAEL CLARKE | 09-09-000598 | Cigna | Quality Unit (RM) | Refill medications | 10,000 - 12,000 | waiting for GOP | c/o Ekapsorn | Not Cover | 13/01/2023 | YES | SENT TO RM | |||||||||||||
85 | 13/1/2023, 15:42:53 | MR.CHRISTOPHER ROBERT PARDY | 0914010589 | Cigna | cardio | CT Calcium Score And Stress Echocardiogram | 18900 | 22/1/2023 | ภัทราพร RN | Cover | 13/01/2023 | YES | call no answer, sent email instead | |||||||||||||
86 | 14/1/2023, 9:16:49 | MS. RAVISARA GROVER | 09-10017651 | Cigna | allergy clinic | Immunotherapy mite+cat+dog injection allergy | 47,420 bath | 20/01/2023 | suteera rn | On process | 14/01/2023 | 20/01/2023 | ||||||||||||||
87 | 14/1/2023, 15:01:05 | LUONG XUAN NGUYEN | 09-04-003228 | Cigna | checkup | golden active | 29900 | 1/02/2023 | nuttanee | Cover | 14/01/2023 | yes | ||||||||||||||
88 | 14/1/2023, 15:02:20 | CHRISTINE MARIE NGUYEN | 09-01-015762 | Cigna | checkup | golden active | 37900 | 1/02/2023 | Nuttanee | Cover | 14/01/2023 | yes | ||||||||||||||
89 | 14/1/2023, 15:28:45 | MS. EBRU GURELI | 09-18-015626 | Cigna | shoulder and joint | Arthroscopic lateral meniscus right knee | 450,000-590,000 baht med clearance 15,000 baht | wait GOP | Thanyalak | Cover | 14/01/2023 | 31/01/2023 | yes | |||||||||||||
90 | 15/1/2023, 10:43:17 | MS.NARUMON INTARABAN | 0912023334 | OTHERS | OBG | Cesarean section | 99,900 | EDC 17/02/2023 | Achara k. | Cover | 15/01/2023 | 19/01/2023 | yes | |||||||||||||
91 | 15/1/2023, 12:07:01 | MS. CHRISTINA CONLON | 0922064695 | Cigna | rehab | PT Programs | 3,000 | 15/1/2023 Dep.ค่าใช้จ่ายรอประกะนตอบกลับ | อาภาพร | Cover | 15/01/2023 | yes | ||||||||||||||
92 | 15/1/2023, 14:32:38 | MRS. JANINE RICHTER | 09-12-009536 | NZI / Euro Center | Skin | Excision biopsy and CO2 Laser | 22,450 | 29/01/2023 | Arporn | Cover | 15/01/2023 | 26/01/2023 | ||||||||||||||
93 | 16/1/2023, 10:31:11 | MR. MICHAEL ANTHONY HAUGEN | 09-22-062591 | Cigna | rehab | ESWT , Dry needling , PT Programs | ESWT = 5,300 baht, Dry needling=3,600 baht , PT Programs = 3,000 baht | 18/1/2023 | อาภาพร | Cover | 16/01/2023 | yes | call | |||||||||||||
94 | 16/1/2023, 10:41:20 | MR. MICHAEL ANTHONY HAUGEN | 09-22-062591 | Cigna | rehab | PMS | 3,350 | 16/1/2023 | อาภาพร | Cover | 16/01/2023 | yes | call | |||||||||||||
95 | 16/1/2023, 11:53:13 | MR. SHANE JOHN LEWIS | 0923000071 | Euro-center | rehab | ESWt,PMS,HPLT,PT Programs | ESWT=3,800 baht ,PMS=3,250 baht ,HPLT=3,300 baht, PT Programs=1,400 baht | 16/1/2023 ผป.Dep. | อาภาพร | DO PROCEDURE BEFORE APPROVAL | 16/01/2023 | 04/02/2023 | ||||||||||||||
96 | 16/1/2023, 12:14:58 | MR. SHANE JOHN LEWIS | 09-23-000071 | Euro-center | rehab | Dry needling | 3,550 | รอประกับตอบกลับ | อาภาพร | DO PROCEDURE BEFORE APPROVAL | 16/01/2023 | 04/02/2023 | ||||||||||||||
97 | 16/1/2023, 13:55:51 | MR.NEILL MARTIN BIRD | 0923001110 | OTHERS | NEURO CENTER | MRI BRAIN +- CONTRAST | 22,565 | ASAP AFTER GET GOP | LIPIKAR | Not Cover | 16/01/2023 | 28/01/2023 | yes | |||||||||||||
98 | 16/1/2023, 14:29:54 | MS. LAURE CECILE ROMEYER | 09-16-037774 | MSH China | skin | Excision biopsy 2 spot | 27550 THB | 23/01/23 | Natcha | DO PROCEDURE BEFORE APPROVAL | 16/01/2023 | 23/01/2023 | ||||||||||||||
99 | 16/1/2023, 14:42:27 | MISS LALIN THURAWAT | Aetna | Surgery Department | excision of preauricular sinus | 85,000-98,000 baht | ยังไม่ได้ระบุวันนัด รอประกันตอบกลับ | มัลวิภา | Cover | 16/01/2023 | yes | call | ||||||||||||||
100 | 16/1/2023, 16:25:23 | MR. JONATHAN TSE | 09-22-074799 | OTHERS | surgery | closure of illeostomy | 180,000-250,000 | 18/1/2023 | patsiree | Cover | 16/01/2023 | yes | call |