Member	Reference Number	Service Date(s)	Service Provider	Status	Submitted Charges	Paid by Plan	Member Responsibility
AMY M PAYNE	8680823209991	08/15/2008	GREEN MD RALPH MICHAEL	PAID	$204.00	$102.49	$20.00
AMY M PAYNE	8680817704696	06/19/2008	RAO MD RAMESH K	PAID	$84.00	$61.39	$0.00
AMY M PAYNE	8680819303530	06/19/2008	BAPTIST HSP OF E TN	DENIED	$91.00	$0.00	$0.00
AMY M PAYNE	8680815601833	06/02/2008	COFER MD KENNETH F	PAID	$125.00	$68.04	$30.00
AMY M PAYNE	8680816406806	06/02/2008	BOPPANA MD SRINIVAS	PAID	$82.00	$52.00	$30.00
AMY M PAYNE	8680815809089	05/20/2008	GREEN MD RALPH MICHAEL	PAID	$43.00	$21.32	$20.00
AMY M PAYNE	8680816204879	05/19/2008	CLAIBORNE CNTY HSP	PAID	$204.00	$112.80	$30.00
AMY M PAYNE	8680812906820	04/29/2008	BOPPANA MD SRINIVAS	PAID	$10,055.00	$10,055.00	$0.00
AMY M PAYNE	8680812906819	04/22/2008 - 04/29/2008	BOPPANA MD SRINIVAS	PAID	$32,185.00	$32,185.00	$0.00
AMY M PAYNE	8680814206244	04/15/2008	CLAIBORNE CNTY HSP	PROCESSED	$112.00	$0.00	$0.00
AMY M PAYNE	8680813106050	04/01/2008 - 04/14/2008	BAPTIST HSP OF E TN	PAID	$6,071.00	$3,672.95	$0.00
AMY M PAYNE	8680810398503	03/17/2008 - 03/31/2008	BAPTIST HSP OF E TN	PAID	$6,378.00	$3,858.68	$0.00
AMY M PAYNE	8680810388503	03/06/2008 - 03/14/2008	BAPTIST HSP OF E TN	PAID	$10,779.75	$4,456.35	$0.00
AMY M PAYNE	8680806803811	03/04/2008	EBENEZER MD ALBERT C S	PAID	$164.00	$56.68	$30.00
AMY M PAYNE	8680807208320	03/04/2008	BOPPANA MD SRINIVAS	PAID	$398.00	$398.00	$0.00
AMY M PAYNE	8680808510014	03/04/2008	BOPPANA MD SRINIVAS	DENIED	$398.00	$0.00	$0.00
AMY M PAYNE	8680806601967	02/28/2008	COFER MD KENNETH F	PAID	$75.00	$30.39	$30.00
AMY M PAYNE	8680814208910	02/26/2008 - 04/14/2008	RAO MD RAMESH K	PAID	$4,711.00	$2,891.40	$0.00
AMY M PAYNE	8680806800539	02/25/2008	RAO MD RAMESH K	PAID	$171.00	$160.70	$0.00
AMY M PAYNE	8680807110124	02/25/2008	BAPTIST HSP OF E TN	DENIED	$91.00	$0.00	$0.00
AMY M PAYNE	8680804003206	02/06/2008	KRISNAMOORTHY CRNA MICHEL	PAID	$1,966.50	$1,671.53	$0.00
AMY M PAYNE	8680805004144	02/06/2008	COFER MD KENNETH F	PAID	$2,800.00	$2,133.93	$0.00
AMY M PAYNE	8680806800120	02/06/2008 - 02/07/2008	ST MARYS MED CTR	PAID	$19,653.31	$2,209.91	$50.00
AMY M PAYNE	8680803502305	01/29/2008	CUMBERLAND MED LABORATOR	PAID	$85.00	$85.00	$0.00
AMY M PAYNE	8680802798725	01/24/2008	COFER MD KENNETH F	PAID	$300.00	$229.02	$30.00
AMY M PAYNE	8680801797648	01/09/2008	RICHARDSON CRNA CHRIS	PAID	$724.50	$615.83	$0.00
AMY M PAYNE	8680802419182	01/09/2008	VICK II MD GEORGE W	PAID	$900.00	$298.77	$0.00
AMY M PAYNE	8680801400603	01/08/2008	QUEST DIAG CLINICAL LAB	PAID	$181.20	$20.77	$0.00
AMY M PAYNE	8680801917305	01/08/2008 - 01/09/2008	ST MARYS MED CTR	PAID	$5,009.89	$949.44	$50.00
AMY M PAYNE	8680801492232	01/07/2008	GREEN MD RALPH MICHAEL	PAID	$60.00	$37.71	$20.00
AMY M PAYNE	8680801108079	01/02/2008	APPLC	PAID	$94.00	$36.96	$0.00
					$104,196.15	$66,472.06	$340.00