On April 22, 2014 a
HEALTH INSURANCE CARD INFORMATION
was filed
involving a dispute between
and
for MODIFICATION-OTHER
in the District Court of Tarrant County.
Preview
Case: 325-555760-14
Health Insurance Card Information
As requested in the final order please find enclosed ALIA G. HAIDER health
insurance· information.
Regards
Parent: SHABBAB HAIDER
February 15, 2015 ('.
- ..
f'
~
T: (408) 858-2784
E: shabbab@msn.com
Note: Case file still have Alia's old name, as Alia A Ali which has been changed to Alia G.
Haider as per the temporary and final order. Please update the record as appropriate, Thank you.
& lfi1 BJueCros..ct RlueShJefd
.T Q ol'Texu.•
Member Name Network No. PTXOA
ALIA G HAIDER
Member ID
ZGP893766670 TDI
Group No. 000700 Plan SelecTEMP PPO
BIN 011552
RxPCN BCTX
Plan Code BC ·400 BS 900 Rx Deductible $200
Effective Date 01/01/15 Rx Copay Generic $10 Brand $40/$55
Expiration Date 07/01/15
www.bcbstx.com
wV
~ (fi') BlueCro!\.«. BlueShield
otTcxas
Member Customer Service:
Pre-Authorization:
1-888-697..0683
1..S00-441-9188
See your benefit booklet for services requiring
pre-authorization and claims filing address.
File MEDICAL CLAIMS w.th your local Blue
Cross and Blue Shield Plan.
In Networ'~ coverage is avaHab!e through
B!ueCholce™ Network Provider. Out-of-Network A. ~ of H-..a!'.h Care SeM::e Corpota1iol'l, a Mutual
services wm be covered at a lower level. Legal ~ ~ . an Independent l.ioeflsee of the
B!u9 Cross and Blue St1cld Assoa.aoon.
;aPRltv1E Pharmacy Benefits Manager
fH!l'&.l'!t:T7CS"'
-
Humana,
DHMO (Hl215)
Sub: ALIA G HAIDER
MbrName:
AUAGHAIOER Cov Type: SUB
Plan Code: Hl15TX
PCDName: Eff Date: 01101J2015
PCD UHASSIGNED
T.D.I. 1I
I
_j
Register on HumanaOneMembets.com to obtain your certificate
of coverage or call the member/pt'Ovider service number below.
Member!Provider Service: 1-866-537-0232
Humana Specialty Benefits
P.O. Box 14283
Lexington, KY 40512-4283
8edronic Claims Submitted Payer ID: CX021
Humana Dental Insurance Company Card Issued: 12/1912014
L ____._.....
;---,..,.... ........ -'!" ............ - ~ · - . . . . _.,.. ____ ,. ___ ":._.,.. --~-----:~~,---···:····----··-·-:- • ... - - - - - - - - - - - ... - - - - - - ... - - - - - ...... - - - - - ...... - - - - - ... - - - - ... - - - - - - - ... - -
Using your VSJ» benefit is easy.
• Find the eye care provider who's right for you.
vsp.
•
To find a VSP doctor, visit vsp.com or call aoo.sn.7195.
• Review your benefit information at vsp.com before your
Coverage Type: Member Only
appointment
Doctor Network: VSP ChOiee
N. your appointment. tell them you have VSP.
Copays:
Exam: $15.00 Materials.· $25.00 My Eye Care Provider: _ _ _ _ _ _ _ __
Phone=-~-------------
Th11 e,,rt1"' M l ~ r,,, ...,...,,. - - rd gu_,..,., ~ eiqbl,1)1 II ii l'ot
t,,,t-n -
Wllo<'nal,on and JO<"
i - by VSF' ''''""~ In !NI.....-.! a! I co,.!!,ct
c,rgar,tn~~·, comtcl "'1!tl V!:P. 1114 t~m,s d
h C(l'lt,a •eSu:e.,n.r.., 111=.-,eeOM$ion.
·------------·----··---·-------------····---------------------------------------------------·--·----------------
Document Filed Date
March 05, 2015
Case Filing Date
April 22, 2014
Category
MODIFICATION-OTHER
Status
FINAL JUDGMENT AFTER NON-JURY TRIAL
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Preview
Case: 325-555760-14 Health Insurance Card Information As requested in the final order please find enclosed ALIA G. HAIDER health insurance· information. Regards Parent: SHABBAB HAIDER February 15, 2015 ('. - .. f' ~ T: (408) 858-2784 E: shabbab@msn.com Note: Case file still have Alia's old name, as Alia A Ali which has been changed to Alia G. Haider as per the temporary and final order. Please update the record as appropriate, Thank you. & lfi1 BJueCros..ct RlueShJefd .T Q ol'Texu.• Member Name Network No. PTXOA ALIA G HAIDER Member ID ZGP893766670 TDI Group No. 000700 Plan SelecTEMP PPO BIN 011552 RxPCN BCTX Plan Code BC ·400 BS 900 Rx Deductible $200 Effective Date 01/01/15 Rx Copay Generic $10 Brand $40/$55 Expiration Date 07/01/15 www.bcbstx.com wV ~ (fi') BlueCro!\.«. BlueShield otTcxas Member Customer Service: Pre-Authorization: 1-888-697..0683 1..S00-441-9188 See your benefit booklet for services requiring pre-authorization and claims filing address. File MEDICAL CLAIMS w.th your local Blue Cross and Blue Shield Plan. In Networ'~ coverage is avaHab!e through B!ueCholce™ Network Provider. Out-of-Network A. ~ of H-..a!'.h Care SeM::e Corpota1iol'l, a Mutual services wm be covered at a lower level. Legal ~ ~ . an Independent l.ioeflsee of the B!u9 Cross and Blue St1cld Assoa.aoon. ;aPRltv1E Pharmacy Benefits Manager fH!l'&.l'!t:T7CS"' - Humana, DHMO (Hl215) Sub: ALIA G HAIDER MbrName: AUAGHAIOER Cov Type: SUB Plan Code: Hl15TX PCDName: Eff Date: 01101J2015 PCD UHASSIGNED T.D.I. 1I I _j Register on HumanaOneMembets.com to obtain your certificate of coverage or call the member/pt'Ovider service number below. Member!Provider Service: 1-866-537-0232 Humana Specialty Benefits P.O. Box 14283 Lexington, KY 40512-4283 8edronic Claims Submitted Payer ID: CX021 Humana Dental Insurance Company Card Issued: 12/1912014 L ____._..... ;---,..,.... ........ -'!" ............ - ~ · - . . . . _.,.. ____ ,. ___ ":._.,.. --~-----:~~,---···:····----··-·-:- • ... - - - - - - - - - - - ... - - - - - - ... - - - - - ...... - - - - - ...... - - - - - ... - - - - ... - - - - - - - ... - - Using your VSJ» benefit is easy. • Find the eye care provider who's right for you. vsp. • To find a VSP doctor, visit vsp.com or call aoo.sn.7195. • Review your benefit information at vsp.com before your Coverage Type: Member Only appointment Doctor Network: VSP ChOiee N. your appointment. tell them you have VSP. Copays: Exam: $15.00 Materials.· $25.00 My Eye Care Provider: _ _ _ _ _ _ _ __ Phone=-~------------- Th11 e,,rt1"' M l ~ r,,, ...,...,,. - - rd gu_,..,., ~ eiqbl,1)1 II ii l'ot t,,,t-n - Wllo<'nal,on and JO<" i - by VSF' ''''""~ In !NI.....-.! a! I co,.!!,ct c,rgar,tn~~·, comtcl "'1!tl V!:P. 1114 t~m,s d h C(l'lt,a •eSu:e.,n.r.., 111=.-,eeOM$ion. ·------------·----··---·-------------····---------------------------------------------------·--·----------------