40007-262701-1.pdf
PDF 363 KB Posted
- Attached to
- Sports Insurance - Current Insurance Coverage
- Solicitation number
- 40007-262701
- Issued by
- East Baton Rouge Parish, Baton Rouge City, Louisiana
About this file
This is an addendum to an Invitation to Bid issued by Baton Rouge Community College for intercollegiate sports accident and catastrophic insurance coverage. The addendum, issued July 15, 2026, extends the bid opening date from July 23, 2026 to July 30, 2026, with both openings scheduled for 2:00 P.M. CST. The insurance coverage is required for four NJCAA sports: Men's Basketball (18 athletes), Women's Basketball (18 athletes), Men's Baseball (45 athletes), and Women's Softball (21 athletes). The scope includes accident insurance with a $25,000 core medical benefit, full dental and physical therapy coverage, a three-year benefit period with no aggregate limit, and three alternative deductible structures ($500, $1,000, and $2,500), along with catastrophic insurance with a $25,000 deductible and $5,000,000 maximum benefit. The contract term is twelve months beginning August 15, 2026 and ending August 14, 2027, with options to extend for two additional twelve-month periods at identical prices, terms, and conditions. Sealed bids must be submitted in person to The Mail Bag, 7515 Jefferson Highway #326, Baton Rouge, Louisiana 70806; faxed or emailed bids are not accepted. The addendum confirms that BRCC maintains a certified athletic trainer on staff and references Attachment A, which contains the college's previous insurance information and claims history for vendor review.
The current premium for the 2025-2026 policy year totals $73,932, comprised of $67,772 for accident insurance and $6,160 for catastrophic insurance. Payment is due within thirty days of invoice, delivery, and authorized inspection. BRCC is exempt from state and local sales and use taxes. The attached claims history report covers policy years 2021 through 2025 and includes detailed claim information by underwriting year and coverage type, documenting claims made by student-athletes across all four sports, with information on claim amounts, reductions, and amounts paid. Vendors submitting bids that have already been submitted may acknowledge receipt of this addendum by identifying their business name and signing the acknowledgement form. If the addendum necessitates revisions to an original bid submission, vendors must submit updated bid forms to BRCC prior to the new bid opening date and time of July 30, 2026; revisions received after the opening will not be considered.
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| 40007-262701.doc | DOC document |
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Text version
ADDENDUM No. 1 Issue Date: 07/15/2026
Bid Number: 262701 Sports Insurance
Bids Will Be Publicly Opened: July 30, 2026, at 2:00 P.M. CST
Your reference is directed at BRCC Invitation to Bid 262701 which is scheduled to open on July 30, 2026. Notice is given to all parties that this Solicitation is amended by the College as stated herein. This
Addendum is hereby made an official part of this Solicitation.
The following change is to be made to the referenced solicitation:
Bid Currently Reads: Bids Will Be Publicly Opened: July 23, 2026, at 2:00 P.M. CST
Bid Changed to Read: Bids Will Be Publicly Opened: July 30, 2026, at 2:00 P.M. CST
Questions from Vendor and BRCC’s Responses:
Vendor Question 1: Does this school have athletic medical trainers or a physician team on staff?
BRCC’s Response: Yes, the school has a certified athletic trainer.
Vendor Question 2: Could you please re-attach the previous insurance information and claims history?
The files currently provided will not open for review.
BRCC’s Response: Please refer to Attachment A.
ACKNOWLEDGEMENT: This Addendum is to be signed and returned with your bid. If you have already submitted your bid and this Addendum does not cause you to revise your bid, you may acknowledge receipt of this Addendum by identifying your business name and by signing where indicated and submitting Addendum to BRCC prior to bid opening date and time. BRCC reserves the right to request a completed Acknowledgement at any time. Failure to execute an Acknowledgement shall not relieve the bidder from complying with the terms of the Invitation to Bid.
Signature of Authorized Bidder: Company:
(Must be signed and dated) (Typed or printed)
REVISION: If you have already submitted your bid, and this Addendum creates a need to revise/clarify your original response in any way, you must indicate any change(s) on an updated bid form. You should acknowledge receipt of this Addendum by identifying your business name and by signing where indicated. To be considered, your addendum response must be submitted to and received by the issuing department to the address stated in the original ITB no later than the specified bid due date/time.
Revisions received after bid opening date and time shall not be considered and you shall be held to your original bid.
Signature of Authorized Bidder: Company:
(Must be signed and dated)
Baton Rouge Community College, Policy Begin Year: 2021, Policy End Year: 2025
A-G Administrators, Inc.
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
Baton Rouge Community CollegeClient:
2021Underwriting Year:
174-127-001-PPolicy:
Coverage: Not Specified
Checking Account:
B., Jacob; Claim: 275737; Activity: Men's Basketball; Diagnosis: Pain; Anatomy: Unspecified; Date Incurred: 08/18/2021
08/27/2021 Ded Credit 09/27/2021 0 $167.00 $0.00 09/27/2021$167.00
09/29/2021 Ded Credit 10/06/2021 0 $154.00 $0.00 10/06/2021$154.00
Claim # 275737 Totals : $321.00 $0.00$321.00
B., Jacob; Claim: 278679; Activity: Men's Basketball; Diagnosis: Pain; Anatomy: Knee; Date Incurred: 01/11/2022
01/12/2022 Ded Credit 01/19/2022 0 $355.00 $0.00 01/19/2022$355.00
01/12/2022 Ded Credit 01/19/2022 0 $50.00 $0.00 01/19/2022$50.00
Claim # 278679 Totals : $405.00 $0.00$405.00
B., Jacob; Claim: 281496; Activity: Men's Basketball; Diagnosis: Pain; Anatomy: Knee; Date Incurred: 01/23/2022
04/13/2022 Ded Credit 08/01/2022 0 $355.00 $0.00 08/01/2022$355.00
Claim # 281496 Totals : $355.00 $0.00$355.00
C., Jameison; Claim: 279274; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Shoulder; Date Incurred: 01/14/2022
02/01/2022 Ded Credit 02/24/2022 0 $23.00 $0.00 02/24/2022$23.00
02/01/2022 Ded Credit 03/31/2022 0 $358.00 $0.00 03/31/2022$358.00
03/31/2022 Max Benefit 10/11/2022 0 $2,875.00 $0.00 10/11/2022$2,875.00
03/31/2022 Max Benefit 10/11/2022 0 $1,500.88 $0.00 10/11/2022$1,500.88
03/31/2022 Max Benefit 10/11/2022 0 $545.62 $0.00 10/11/2022$545.62
10/26/2022 Max Benefit 11/14/2022 0 $664.00 $0.00 11/14/2022$664.00
Claim # 279274 Totals : $5,966.50 $0.00$5,966.50 brownd3 Text Box Attachment A
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
D., Alana; Claim: 275510; Activity: Women's Basketball; Diagnosis: Pain; Anatomy: Unspecified; Date Incurred: 08/24/2021
09/20/2021 Ded Credit 10/04/2021 0 $331.00 $0.00 10/04/2021$331.00
09/20/2021 Ded Credit 11/02/2021 0 $40.00 $0.00 11/02/2021$40.00
02/14/2022 Not-payable 03/31/2022 0 $223.00 $0.00 03/31/2022$223.00
02/14/2022 Not-payable 03/31/2022 0 $256.00 $0.00 03/31/2022$256.00
02/14/2022 Not-payable 01/17/2023 0 $223.00 $0.00 01/17/2023$223.00
Claim # 275510 Totals : $1,073.00 $0.00$1,073.00
E., Kelsie; Claim: 279278; Activity: Women's Softball; Diagnosis: Pain; Anatomy: Back; Date Incurred: 02/07/2022
02/14/2022 Other Ins Paid 03/09/2022 0 $256.00 03/09/2022$33.42
03/09/2022 0 03/09/2022Primary Adjustm$162.58
03/09/2022 0 $0.00 03/09/2022Ded Credit$60.00
02/08/2022 Primary Adjustm 03/10/2022 0 $380.00 03/10/2022$251.34
03/10/2022 0 $0.00 03/10/2022Ded Credit$128.66
Claim # 279278 Totals : $636.00 $0.00$636.00
H., Elliot; Claim: 279277; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Ankle; Date Incurred: 01/30/2022
01/31/2022 Primary Adjustm 03/04/2022 0 $167.00 03/04/2022$108.79
03/04/2022 0 $0.00 03/04/2022Ded Credit$58.21
01/31/2022 Primary Adjustm 04/04/2022 0 $511.00 04/04/2022$293.53
04/04/2022 0 $0.00 04/04/2022Ded Credit$217.47
01/31/2022 Primary Adjustm 04/04/2022 0 $20.00 04/04/2022$3.55
04/04/2022 0 $0.00 04/04/2022Ded Credit$16.45
02/01/2022 Primary Adjustm 06/17/2022 0 $154.00 06/17/2022$24.74
06/17/2022 0 $0.00 06/17/2022Ded Credit$129.26
03/25/2022 Not-payable 06/17/2022 0 $60.00 $0.00 06/17/2022$60.00
03/25/2022 Primary Adjustm 06/17/2022 0 $358.00 06/17/2022$216.72
06/17/2022 0 $0.00 06/17/2022Not-payable$141.28
Claim # 279277 Totals : $1,270.00 $0.00$1,270.00
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
L., Rebecka; Claim: 275383; Activity: Women's Softball; Diagnosis: Pain; Anatomy: Shoulder; Date Incurred: 09/07/2021
09/14/2021 Ded Credit 11/01/2021 0 $3.88 11/01/2021$3.88
11/01/2021 0 $0.00 11/01/2021Ded Credit$-3.88
09/14/2021 Ded Credit 11/01/2021 0 $13.08 11/01/2021$13.08
11/01/2021 0 $0.00 11/01/2021Ded Credit$-13.08
09/24/2021 Ded Credit 12/02/2021 0 $50.00 12/02/2021$50.00
12/02/2021 0 $0.00 12/02/2021Ded Credit$-50.00
09/14/2021 Ded Credit 01/03/2022 0 $50.00 01/03/2022$50.00
01/03/2022 0 $0.00 01/03/2022Ded Credit$-50.00
Claim # 275383 Totals : $116.96 $0.00$116.96
M., Ethan; Claim: 277641; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Knee; Date Incurred: 09/27/2021
12/02/2021 Not Covered 12/27/2021 0 $356.38 12/27/2021$356.38
12/27/2021 0 $0.00 12/27/2021Adjustment$356.38
Claim # 277641 Totals : $356.38 $0.00$356.38
S., Hayden; Claim: 275957; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Elbow; Date Incurred: 09/30/2021
10/11/2021 Adjustment 11/18/2021 0 -$30.55 11/18/2021$-30.55
11/18/2021 0 11/18/2021Adjustment$61.10
11/18/2021 0 $0.00 11/18/2021Ded Credit$-30.55
10/11/2021 Ded Credit 11/18/2021 0 $30.55 11/18/2021$30.55
11/18/2021 0 $0.00 11/18/2021Adjustment$-30.55
10/06/2021 Ded Credit 11/18/2021 0 $51.78 11/18/2021$51.78
11/18/2021 0 $0.00 11/18/2021Ded Credit$-51.78
11/16/2021 Other Ins Paid 12/20/2021 0 $80.00 12/20/2021$4.29
12/20/2021 0 12/20/2021Primary Adjustm$35.71
12/20/2021 0 $0.00 12/20/2021Ded Credit$40.00
Claim # 275957 Totals : $131.78 $0.00$131.78
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
S., Montana; Claim: 280301; Activity: Women's Softball; Diagnosis: Pain; Anatomy: Back; Date Incurred: 03/08/2022
05/06/2022 Ded Credit 05/31/2022 0 $45.00 05/31/2022$45.00
05/31/2022 0 $0.00 05/31/2022Ded Credit$-45.00
05/04/2022 Ded Credit 05/31/2022 0 $45.00 05/31/2022$45.00
05/31/2022 0 $0.00 05/31/2022Ded Credit$-45.00
Claim # 280301 Totals : $90.00 $0.00$90.00
$10,721.62 $10,721.62 $0.002021 Sub Total: Checking Account Totals:
Checking Account: FA-Guarantee Trust Life Insurance Compan
B., Jacob; Claim: 275737; Activity: Men's Basketball; Diagnosis: Pain; Anatomy: Unspecified; Date Incurred: 08/18/2021
08/27/2021 Ded Credit 05/03/2022 2330060574 Ochsner Medical Center $358.00 $179.00 04/21/2022$179.00
08/27/2021 05/03/2022 2330060575 Ochsner Clinic LLC $20.00 $20.00 04/21/2022$0.00
10/11/2021 Disc:OccuNet 06/02/2022 2330062173 Ochsner Medical Center $2,855.00 11/10/2021$651.25
06/02/2022 2330062173 $250.00 11/10/2021Disc:OccuNet$1,953.75
10/11/2021 06/02/2022 2330062174 OccuNet $651.25 $651.25 11/10/2021$0.00
09/29/2021 Disc:OccuNet 06/02/2022 2330062170 Ochsner Medical Center $1,408.00 10/12/2021$300.57
06/02/2022 2330062170 $205.73 10/12/2021Disc:OccuNet$901.70
09/29/2021 06/02/2022 2330062175 OccuNet $300.57 $300.57 10/12/2021$0.00
11/10/2021 Disc:OccuNet 06/02/2022 2330062171 Ochsner Medical Center $1,587.00 12/13/2021$359.25
06/02/2022 2330062171 $150.00 12/13/2021Disc:OccuNet$1,077.75
11/10/2021 06/02/2022 2330062172 OccuNet $359.25 $359.25 12/13/2021$0.00
Claim # 275737 Totals : $7,539.07 $2,115.80$5,423.27
B., Jacob; Claim: 278679; Activity: Men's Basketball; Diagnosis: Pain; Anatomy: Knee; Date Incurred: 01/11/2022
01/12/2022 02/28/2022 2330057017 OccuNet $397.67 $397.67 01/25/2022$0.00
01/12/2022 Disc:OccuNet 02/28/2022 2330057016 Ochsner Medical Center $1,800.00 01/25/2022$397.67
02/28/2022 2330057016 $209.31 01/25/2022Disc:OccuNet$1,193.02
01/12/2022 03/03/2022 2330057248 Ochsner Clinic LLC $154.00 $154.00 02/15/2022$0.00
01/13/2022 Ded Credit 03/03/2022 2330057247 Ochsner Clinic LLC $256.00 $161.00 02/16/2022$95.00
Claim # 278679 Totals : $2,607.67 $921.98$1,685.69
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
B., Jacob; Claim: 281496; Activity: Men's Basketball; Diagnosis: Pain; Anatomy: Knee; Date Incurred: 01/23/2022
04/07/2022 Ded Credit 08/29/2022 2330066396 Ochsner Clinic LLC $256.00 $111.00 05/10/2022$145.00
04/08/2022 08/29/2022 2330066398 Ochsner Clinic LLC $154.00 $154.00 07/21/2022$0.00
04/07/2022 08/29/2022 2330066397 Ochsner Clinic LLC $50.00 $50.00 05/10/2022$0.00
Claim # 281496 Totals : $460.00 $315.00$145.00
C., Jameison; Claim: 279274; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Shoulder; Date Incurred: 01/14/2022
02/01/2022 Ded Credit 04/26/2022 2330060114 Ochsner Clinic LLC $307.00 $188.00 04/13/2022$119.00
03/31/2022 Max Benefit 04/26/2022 2330060115 Ochsner Medical Center $41,275.07 $24,812.00 04/18/2022$16,463.07
Claim # 279274 Totals : $41,582.07 $25,000.00$16,582.07
D., Alana; Claim: 275510; Activity: Women's Basketball; Diagnosis: Pain; Anatomy: Unspecified; Date Incurred: 08/24/2021
09/20/2021 Over UCR 11/10/2021 2330052286 Ochsner Clinic LLC $358.00 11/02/2021$128.79
11/10/2021 2330052286 $100.21 11/02/2021Ded Credit$129.00
10/01/2021 Disc:OccuNet 05/12/2022 2330061083 Ochsner Clinic LLC $511.00 03/31/2022$86.93
05/12/2022 2330061083 $163.28 03/31/2022Disc:OccuNet$260.79
10/01/2021 05/12/2022 2330061084 OccuNet $86.93 $86.93 03/31/2022$0.00
05/26/2022 Disc:OccuNet 08/10/2022 2330065499 Ochsner Clinic LLC $355.00 06/06/2022$50.17
08/10/2022 2330065499 $154.34 06/06/2022Disc:OccuNet$150.49
05/26/2022 08/10/2022 2330065498 OccuNet $50.17 $50.17 06/06/2022$0.00
Claim # 275510 Totals : $1,361.10 $554.93$806.17
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
E., Kelsie; Claim: 279278; Activity: Women's Softball; Diagnosis: Pain; Anatomy: Back; Date Incurred: 02/07/2022
03/23/2022 Primary Adjustm 05/03/2022 2330060576 Radiology Specialists $1,150.00 04/21/2022$785.91
05/03/2022 2330060576 04/21/2022Ded Credit$311.34
05/03/2022 2330060576 $86.17 04/21/2022Ded Credit$-33.42
02/08/2022 Primary Adjustm 06/01/2022 2330062107 Ochsner Clinic LLC $40.00 $31.82 05/19/2022$8.18
02/08/2022 Primary Adjustm 06/01/2022 2330062108 Ochsner Clinic LLC $355.00 05/24/2022$217.10
06/01/2022 2330062108 $60.00 05/24/2022Other Ins Paid$77.90
03/07/2022 Other Ins Paid 07/05/2022 2330063729 Geaux Chiro $2,725.00 06/21/2022$713.53
07/05/2022 2330063729 06/21/2022Primary Adjustm$1,261.71
07/05/2022 2330063729 $560.00 06/21/2022Primary Adjustm$189.76
Claim # 279278 Totals : $4,270.00 $737.99$3,532.01
G., Braxton; Claim: 280671; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Hamstring; Date Incurred: 01/14/2022
04/01/2022 Primary Adjustm 01/12/2023 2330072308 Ochsner Medical Center $1,102.00 12/28/2022$208.00
01/12/2023 2330072308 $394.00 12/28/2022Ded Credit$500.00
Claim # 280671 Totals : $1,102.00 $394.00$708.00
G., Alex; Claim: 276327; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Hamstring; Date Incurred: 10/10/2021
11/02/2021 Primary Adjustm 02/23/2022 2330056761 Ochsner Medical Center $3,234.00 02/07/2022$1,470.31
02/23/2022 2330056761 $352.74 02/07/2022Other Ins Paid$1,410.95
10/18/2021 Other Ins Paid 09/01/2022 2330066624 Ochsner Clinic LLC $355.00 01/04/2022$115.66
09/01/2022 2330066624 $25.00 01/04/2022Primary Adjustm$214.34
10/14/2021 Primary Adjustm 12/13/2022 2330070846 Ochsner Medical Center $1,410.00 02/07/2022$421.32
12/13/2022 2330070846 $527.74 02/07/2022Other Ins Paid$460.94
Claim # 276327 Totals : $4,999.00 $905.48$4,093.52
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
H., Elliot; Claim: 279277; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Ankle; Date Incurred: 01/30/2022
02/23/2022 Primary Adjustm 09/22/2022 2330067388 Ochsner Medical Center $1,539.00 06/07/2022$699.57
09/22/2022 2330067388 06/07/2022Ded Credit$78.61
09/22/2022 2330067388 $150.00 06/07/2022Misc. Conversion$610.82
02/23/2022 09/22/2022 2330067391 OccuNet $172.36 $172.36 06/07/2022$0.00
02/01/2022 Primary Adjustm 09/22/2022 2330067389 Ochsner Medical Center $1,408.00 06/07/2022$420.35
09/22/2022 2330067389 06/07/2022Disc:OccuNet$194.59
09/22/2022 2330067389 $209.31 06/07/2022Disc:OccuNet$583.75
02/01/2022 09/22/2022 2330067390 OccuNet $194.59 $194.59 06/07/2022$0.00
Claim # 279277 Totals : $3,313.95 $726.26$2,587.69
L., Rebecka; Claim: 275383; Activity: Women's Softball; Diagnosis: Pain; Anatomy: Shoulder; Date Incurred: 09/07/2021
10/08/2021 Other Ins Paid 03/08/2022 2330057478 BROC Therapy Services $775.00 02/23/2022$46.16
03/08/2022 2330057478 $244.63 02/23/2022Primary Adjustm$484.21
10/01/2021 Other Ins Paid 03/08/2022 2330057477 BROC Therapy Services $325.00 02/22/2022$99.98
03/08/2022 2330057477 $50.00 02/22/2022Primary Adjustm$175.02
09/16/2021 Other Ins Paid 03/08/2022 2330057480 Ochsner Clinic LLC $182.00 02/22/2022$136.09
03/08/2022 2330057480 $34.02 02/22/2022Primary Adjustm$11.89
09/16/2021 Primary Adjustm 03/08/2022 2330057479 Ochsner Clinic LLC $413.00 02/22/2022$236.57
03/08/2022 2330057479 $35.29 02/22/2022Other Ins Paid$141.14
09/24/2021 Primary Adjustm 03/24/2022 2330058425 Ochsner Clinic LLC $256.00 12/02/2021$140.12
03/24/2022 2330058425 $50.00 12/02/2021Other Ins Paid$65.88
09/14/2021 Other Ins Paid 03/24/2022 2330058427 Ochsner Clinic LLC $23.00 11/01/2021$15.52
03/24/2022 2330058427 $3.88 11/01/2021Primary Adjustm$3.60
09/14/2021 Primary Adjustm 03/24/2022 2330058424 Ochsner Clinic LLC $358.00 01/03/2022$191.14
03/24/2022 2330058424 $50.00 01/03/2022Other Ins Paid$116.86
09/16/2021 Other Ins Paid 03/24/2022 2330058428 Ochsner Medical Center $2,581.98 03/14/2022$661.60
03/24/2022 2330058428 $490.40 03/14/2022Primary Adjustm$1,429.98
09/14/2021 Primary Adjustm 03/24/2022 2330058426 Ochsner Medical Center $174.00 11/01/2021$108.58
03/24/2022 2330058426 $13.08 11/01/2021Other Ins Paid$52.34
Claim # 275383 Totals : $5,087.98 $971.30$4,116.68
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
M., Ethan; Claim: 277641; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Knee; Date Incurred: 09/27/2021
12/08/2021 Other Ins Paid 01/04/2022 2330054215 Moreau Physical Therapy $335.00 12/27/2021$136.29
01/04/2022 2330054215 $34.08 12/27/2021Primary Adjustm$164.63
12/09/2021 Other Ins Paid 01/04/2022 2330054214 Moreau Physical Therapy $218.00 12/27/2021$99.63
01/04/2022 2330054214 $24.91 12/27/2021Primary Adjustm$93.46
12/13/2021 Primary Adjustm 01/18/2022 2330054824 Moreau Physical Therapy $872.00 01/03/2022$373.84
01/18/2022 2330054824 $99.64 01/03/2022Other Ins Paid$398.52
11/24/2021 Other Ins Paid 01/19/2022 2330054933 Opelousas General Health $530.00 01/11/2022$113.88
01/19/2022 2330054933 $68.02 01/11/2022Primary Adjustm$348.10
12/29/2021 Other Ins Paid 02/02/2022 2330055612 Moreau Physical Therapy $218.00 01/18/2022$27.59
02/02/2022 2330055612 $96.95 01/18/2022Primary Adjustm$93.46
11/19/2021 Primary Adjustm 02/25/2022 2330056943 Ochsner Clinic LLC $23.00 $19.28 02/11/2022$3.72
11/19/2021 Primary Adjustm 02/25/2022 2330056942 Ochsner Clinic LLC $358.00 $141.28 02/10/2022$216.72
12/02/2021 Other Ins Paid 02/28/2022 2330057019 Opelousas General Health $1,632.00 02/11/2022$677.00
02/28/2022 2330057019 $162.54 02/11/2022Primary Adjustm$792.46
11/19/2021 Primary Adjustm 02/28/2022 2330057018 Ochsner Medical Center $1,800.00 02/10/2022$675.70
02/28/2022 2330057018 $224.86 02/10/2022Other Ins Paid$899.44
11/19/2021 Primary Adjustm 02/28/2022 2330057020 Ochsner Clinic LLC $27.00 $22.54 02/11/2022$4.46
12/02/2021 Other Ins Paid 03/18/2022 2330058083 Doctors Anesthesia $416.00 03/03/2022$329.89
03/18/2022 2330058083 $82.47 03/03/2022Primary Adjustm$3.64
12/02/2021 Other Ins Paid 06/24/2022 2330063265 ASC of Opelousas $1,916.90 $356.38 12/27/2021$1,560.52
12/27/2021 Other Ins Paid 08/08/2022 2330065400 Moreau Physical Therapy $218.00 07/22/2022$99.63
08/08/2022 2330065400 $24.91 07/22/2022Primary Adjustm$93.46
11/19/2021 Primary Adjustm 09/01/2022 2330066625 Ochsner Clinic LLC $154.00 02/11/2022$154.00
09/01/2022 2330066625 $129.26 02/11/2022Primary Adjustm$-129.26
Claim # 277641 Totals : $8,717.90 $1,487.12$7,230.78
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
P., Sarah; Claim: 280290; Activity: Women's Softball; Diagnosis: Pain; Anatomy: Shoulder; Date Incurred: 03/07/2022
04/01/2022 Other Ins Paid 05/17/2022 2330061303 BRRG $635.00 05/06/2022$103.36
05/17/2022 2330061303 $25.84 05/06/2022Primary Adjustm$505.80
04/01/2022 Primary Adjustm 05/17/2022 2330061304 BRRG $250.00 05/06/2022$126.36
05/17/2022 2330061304 $24.73 05/06/2022Other Ins Paid$98.91
04/01/2022 Primary Adjustm 07/21/2022 2330064465 Baton Rouge General Medical Center $4,037.45 04/29/2022$1,581.34
07/21/2022 2330064465 $1,925.53 04/29/2022Other Ins Paid$530.58
07/19/2022 Adjustment 07/21/2022 2330064464 Baton Rouge General Medical Center $0.00 $0.00 07/19/2022$24.06
03/18/2022 Primary Adjustm 04/11/2023 2330078223 Ochsner Clinic LLC $23.00 03/31/2022$3.72
04/11/2023 2330078223 $3.86 03/31/2022Other Ins Paid$15.42
03/18/2022 Other Ins Paid 04/11/2023 2330078222 Ochsner Clinic LLC $358.00 03/31/2022$113.02
04/11/2023 2330078222 $28.26 03/31/2022Primary Adjustm$216.72
Claim # 280290 Totals : $5,303.45 $2,008.22$3,295.23
S., Hayden; Claim: 275957; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Elbow; Date Incurred: 09/30/2021
11/02/2021 Other Ins Paid 02/03/2022 2330055703 BROC Therapy Services $620.00 01/25/2022$144.88
02/03/2022 2330055703 $62.06 01/25/2022Primary Adjustm$413.06
11/17/2021 Other Ins Paid 02/03/2022 2330055704 BROC Therapy Services $310.00 01/25/2022$72.44
02/03/2022 2330055704 $31.03 01/25/2022Primary Adjustm$206.53
10/14/2021 Other Ins Paid 03/15/2022 2330057892 BROC Therapy Services $1,550.00 02/25/2022$356.65
03/15/2022 2330057892 $152.75 02/25/2022Primary Adjustm$1,040.60
10/06/2021 Other Ins Paid 03/15/2022 2330057893 BROC Therapy Services $510.00 11/18/2021$120.88
03/15/2022 2330057893 $51.78 11/18/2021Primary Adjustm$337.34
10/11/2021 Other Ins Paid 03/15/2022 2330057894 BROC Therapy Services $310.00 11/18/2021$71.33
03/15/2022 2330057894 $30.55 11/18/2021Primary Adjustm$208.12
11/05/2021 Other Ins Paid 03/15/2022 2330057895 BROC Therapy Services $310.00 12/20/2021$72.44
03/15/2022 2330057895 $31.03 12/20/2021Primary Adjustm$206.53
Claim # 275957 Totals : $3,610.00 $359.20$3,250.80
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
S., Montana; Claim: 280301; Activity: Women's Softball; Diagnosis: Pain; Anatomy: Back; Date Incurred: 03/08/2022
04/06/2022 Primary Adjustm 06/28/2022 2330063397 Ochsner Medical Center $1,415.00 06/16/2022$456.17
06/28/2022 2330063397 $541.30 06/16/2022Other Ins Paid$417.53
05/27/2022 Other Ins Paid 07/15/2022 2330064208 LMG LLC $320.00 06/27/2022$106.75
07/15/2022 2330064208 $30.00 06/27/2022Primary Adjustm$183.25
04/06/2022 Primary Adjustm 08/09/2022 2330065459 Ochsner Clinic LLC $168.00 $137.64 07/29/2022$30.36
05/06/2022 Other Ins Paid 08/09/2022 2330065458 LMG LLC $320.00 05/31/2022$54.32
08/09/2022 2330065458 $45.00 05/31/2022Primary Adjustm$220.68
05/04/2022 Other Ins Paid 08/09/2022 2330065460 LMG LLC $215.00 05/31/2022$23.74
08/09/2022 2330065460 $45.00 05/31/2022Primary Adjustm$146.26
06/24/2022 Other Ins Paid 09/01/2022 2330066626 LMG LLC $215.00 08/11/2022$21.79
09/01/2022 2330066626 $45.00 08/11/2022Primary Adjustm$148.21
Claim # 280301 Totals : $2,653.00 $843.94$1,809.06
$92,607.19 $55,265.97 $37,341.222021 Sub Total: Checking Account FA-Guarantee Trust Life Ins
$103,328.81 $37,341.22$65,987.592021 Sub Total: Coverage Not Specified Totals:
$103,328.81 $65,987.59 $37,341.222021 Sub Total: Policy 174-127-001-P Totals:
$103,328.81 $65,987.59 $37,341.222021 Sub Totals:
2022Underwriting Year:
174-127-001-QPolicy:
Coverage: Not Specified
Checking Account:
J., Britt; Claim: 288193; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Shoulder; Date Incurred: 02/01/2023
03/16/2023 Other Ins Paid 08/29/2023 0 $120.00 08/29/2023$23.78
08/29/2023 0 08/29/2023Ded Credit$55.00
08/29/2023 0 $0.00 08/29/2023Primary Adjustm$41.22
02/14/2023 Other Ins Paid 08/29/2023 0 $464.00 08/29/2023$173.34
08/29/2023 0 08/29/2023Ded Credit$55.00
08/29/2023 0 $0.00 08/29/2023Primary Adjustm$235.66
Claim # 288193 Totals : $584.00 $0.00$584.00
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
W., Antonio; Claim: 288156; Activity: Men's Basketball; Diagnosis: Pain; Anatomy: Knee; Date Incurred: 01/12/2023
01/23/2023 Not-payable 02/24/2023 0 $45.08 02/24/2023$45.08
02/24/2023 0 $0.00 02/24/2023Adjustment$45.08
Claim # 288156 Totals : $45.08 $0.00$45.08
Z., Slade; Claim: 291769; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Shoulder; Date Incurred: 03/08/2023
04/10/2023 Adjustment 08/30/2023 0 $201.00 $0.00 08/30/2023$201.00
Claim # 291769 Totals : $201.00 $0.00$201.00
$830.08 $830.08 $0.002022 Sub Total: Checking Account Totals:
Checking Account: FA-Guarantee Trust Life Insurance Compan
A., Morgan; Claim: 290891; Activity: Women's Softball; Diagnosis: Pain; Anatomy: Knee; Date Incurred: 03/03/2023
03/16/2023 Other Ins Paid 06/30/2023 2330084120 BROC Therapy Services $4,625.00 05/30/2023$599.72
06/30/2023 2330084120 $704.70 05/30/2023Primary Adjustm$3,320.58
Claim # 290891 Totals : $4,625.00 $704.70$3,920.30
F., Lane; Claim: 289723; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Arm; Date Incurred: 02/13/2023
03/09/2023 Other Ins Paid 05/26/2023 2330081496 BROC Therapy Services $1,875.00 05/05/2023$552.24
05/26/2023 2330081496 $200.00 05/05/2023Primary Adjustm$1,122.76
04/06/2023 Other Ins Paid 05/26/2023 2330081495 Baton Rouge Orthopaedic Clinic $120.00 04/24/2023$34.35
05/26/2023 2330081495 $40.00 04/24/2023Primary Adjustm$45.65
03/07/2023 Other Ins Paid 05/26/2023 2330081497 Baton Rouge Orthopaedic Clinic $120.00 03/31/2023$34.35
05/26/2023 2330081497 $40.00 03/31/2023Primary Adjustm$45.65
02/20/2023 Other Ins Paid 05/26/2023 2330081498 Baton Rouge Orthopaedic Clinic $270.00 03/31/2023$111.89
05/26/2023 2330081498 $40.00 03/31/2023Primary Adjustm$118.11
03/27/2023 Other Ins Paid 06/27/2023 2330083748 BROC Therapy Services $850.00 05/30/2023$199.80
06/27/2023 2330083748 $80.00 05/30/2023Primary Adjustm$570.20
03/01/2023 Other Ins Paid 06/27/2023 2330083749 Radiology Specialists $668.00 06/05/2023$143.17
06/27/2023 2330083749 $46.88 06/05/2023Primary Adjustm$477.95
Claim # 289723 Totals : $3,903.00 $446.88$3,456.12
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
I., Jennifer; Claim: 288194; Activity: Women's Softball; Diagnosis: Pain; Anatomy: Unspecified; Date Incurred: 02/09/2023
04/17/2023 Primary Adjustm 06/21/2023 2330083376 Anesthesiology Group Associate $375.00 $273.78 05/25/2023$101.22
04/17/2023 Other Ins Paid 06/21/2023 2330083377 Lake Surgery Center $9,093.00 06/02/2023$2,048.81
06/21/2023 2330083377 $665.62 06/02/2023Primary Adjustm$6,378.57
Claim # 288194 Totals : $9,468.00 $939.40$8,528.60
J., Britt; Claim: 288193; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Shoulder; Date Incurred: 02/01/2023
02/14/2024 Other Ins Paid 04/25/2024 2330103158 Baton Rouge Orthopaedic Clinic $464.00 03/25/2024$173.34
04/25/2024 2330103158 03/25/2024Primary Adjustm$235.66
04/25/2024 2330103158 $35.46 03/25/2024Ded Credit$19.54
Claim # 288193 Totals : $464.00 $35.46$428.54
W., Antonio; Claim: 288156; Activity: Men's Basketball; Diagnosis: Pain; Anatomy: Knee; Date Incurred: 01/12/2023
01/12/2023 Primary Adjustm 03/24/2023 2330077067 Ochsner Medical Center $432.00 $76.72 02/27/2023$355.28
01/31/2023 Other Ins Paid 05/02/2023 2330079636 Ochsner Hospital for Orth $61,641.28 03/03/2023$11,892.02
05/02/2023 2330079636 $6,692.75 03/03/2023Primary Adjustm$43,056.51
01/31/2023 Adjustment 05/02/2023 2330079637 Ochsner Hospital for Orth $0.00 $0.00 04/28/2023$30.80
01/19/2023 Other Ins Paid 05/25/2023 2330081321 Baton Rouge Orthopaedic Clinic $120.00 03/10/2023$18.78
05/25/2023 2330081321 $60.00 03/10/2023Primary Adjustm$41.22
01/13/2023 Other Ins Paid 05/25/2023 2330081320 Baton Rouge Orthopaedic Clinic $410.00 03/10/2023$154.18
05/25/2023 2330081320 $60.00 03/10/2023Primary Adjustm$195.82
01/23/2023 Primary Adjustm 08/25/2023 2330087759 Ochsner Clinic LLC $54.00 $45.08 02/24/2023$8.92
Claim # 288156 Totals : $62,657.28 $6,934.55$55,722.73
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
Z., Slade; Claim: 291769; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Shoulder; Date Incurred: 03/08/2023
09/15/2023 0 $0.00 -$25.00 09/15/2023$0.00
03/30/2023 Other Ins Paid 09/28/2023 2330089579 BROC Therapy Services $1,955.00 09/15/2023$440.96
09/28/2023 2330089579 $100.00 09/15/2023Primary Adjustm$1,414.04
04/17/2023 Other Ins Paid 09/28/2023 2330089577 BROC Therapy Services $2,115.00 09/15/2023$513.91
09/28/2023 2330089577 $125.00 09/15/2023Primary Adjustm$1,476.09
04/13/2023 Primary Adjustm 09/28/2023 2330089578 Baton Rouge Orthopaedic Clinic $120.00 08/30/2023$41.22
09/28/2023 2330089578 $25.00 08/30/2023Other Ins Paid$53.78
04/13/2023 Other Ins Paid 10/27/2023 2330091175 Baton Rouge General Medical Center $120.00 09/15/2023$53.78
10/27/2023 2330091175 $25.00 09/15/2023Primary Adjustm$41.22
03/21/2023 Other Ins Paid 10/27/2023 2330091174 Baton Rouge Orthopaedic Clinic $464.00 08/30/2023$97.22
10/27/2023 2330091174 $131.15 08/30/2023Primary Adjustm$235.63
04/13/2023 11/10/2023 2330091822 Baton Rouge Orthopaedic Clinic $25.00 $25.00 09/15/2023$0.00
03/23/2023 Other Ins Paid 12/22/2023 2330094218 Slade Zeppuhar $560.00 08/30/2023$164.03
12/22/2023 2330094218 $25.00 08/30/2023Primary Adjustm$370.97
01/23/2024 Other Ins Paid 03/14/2024 2330099879 BROC Therapy Services $220.00 02/20/2024$99.84
03/14/2024 2330099879 $25.00 02/20/2024Primary Adjustm$95.16
03/14/2024 Other Ins Paid 05/06/2024 2330103862 BROC Therapy Services $270.00 04/08/2024$120.58
05/06/2024 2330103862 $25.00 04/08/2024Primary Adjustm$124.42
02/21/2024 Primary Adjustm 05/06/2024 2330103863 BROC Therapy Services $2,200.00 $418.08 04/01/2024$1,781.92
06/04/2024 Other Ins Paid 07/29/2024 2330110673 Baton Rouge Orthopaedic Clinic $270.00 07/01/2024$120.58
07/29/2024 2330110673 $25.00 07/01/2024Primary Adjustm$124.42
07/10/2024 Other Ins Paid 08/22/2024 2330112816 Baton Rouge Orthopaedic Clinic $5,450.00 08/01/2024$1,337.88
08/22/2024 2330112816 $334.47 08/01/2024Primary Adjustm$3,777.65
07/10/2024 Other Ins Paid 08/22/2024 2330112815 Baton Rouge Orthopaedic Clinic $1,090.00 08/01/2024$227.44
08/22/2024 2330112815 $56.86 08/01/2024Primary Adjustm$805.70
07/10/2024 Other Ins Paid 02/13/2025 2330124293 Louisana Ortho Surgery $22,056.00 12/24/2024$3,670.14
02/13/2025 2330124293 $917.53 12/24/2024Primary Adjustm$17,468.33
Claim # 291769 Totals : $36,915.00 $2,233.09$34,681.91
$118,032.28 $106,738.20 $11,294.082022 Sub Total: Checking Account FA-Guarantee Trust Life Ins
$118,862.36 $11,294.08$107,568.282022 Sub Total: Coverage Not Specified Totals:
$118,862.36 $107,568.28 $11,294.082022 Sub Total: Policy 174-127-001-Q Totals:
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
$118,862.36 $107,568.28 $11,294.082022 Sub Totals:
2023Underwriting Year:
174-127-001-RPolicy:
Coverage: (FA) BLANKET SPORTS
Checking Account:
B., Cole; Claim: 298642; Activity: Men's Basketball; Diagnosis: Pain; Anatomy: L-Ankle; Date Incurred: 02/09/2024
03/06/2024 Ded Credit 10/21/2024 0 $13.08 10/21/2024$13.08
10/21/2024 0 $0.00 10/21/2024Ded Credit$-13.08
03/08/2024 Ded Credit 10/21/2024 0 $48.42 10/21/2024$48.42
10/21/2024 0 $0.00 10/21/2024Ded Credit$-48.42
03/11/2024 Ded Credit 10/21/2024 0 $13.08 10/21/2024$13.08
10/21/2024 0 $0.00 10/21/2024Ded Credit$-13.08
03/18/2024 Other Ins Paid 04/04/2025 0 $760.00 04/04/2025$50.00
04/04/2025 0 $0.00 04/04/2025Primary Adjustm$424.00
04/03/2024 Other Ins Paid 04/04/2025 0 $4,079.00 04/04/2025$300.00
04/04/2025 0 $0.00 04/04/2025Primary Adjustm$2,063.00
05/03/2024 Other Ins Paid 04/04/2025 0 $2,042.00 04/04/2025$150.00
04/04/2025 0 $0.00 04/04/2025Primary Adjustm$962.00
03/06/2024 Other Ins Paid 04/04/2025 0 $62.60 $0.00 04/04/2025$0.00
03/11/2024 Other Ins Paid 04/04/2025 0 $290.08 04/04/2025$148.10
04/04/2025 0 $0.00 04/04/2025Primary Adjustm$104.96
Claim # 298642 Totals : $7,308.26 $0.00$7,308.26
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
T., John; Claim: 298353; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: R-Hand; Date Incurred: 02/20/2024
02/26/2024 Primary Adjustm 03/26/2024 0 $25.00 $0.00 03/26/2024$5.95
02/26/2024 Primary Adjustm 03/26/2024 0 $172.00 $0.00 03/26/2024$106.58
03/13/2024 Other Ins Paid 04/12/2024 0 $301.00 04/12/2024$82.70
04/12/2024 0 $0.00 04/12/2024Primary Adjustm$178.30
03/21/2024 Other Ins Paid 04/12/2024 0 $301.00 04/12/2024$82.70
04/12/2024 0 $0.00 04/12/2024Primary Adjustm$178.30
03/20/2024 Other Ins Paid 04/12/2024 0 $158.00 04/12/2024$100.13
04/12/2024 0 $0.00 04/12/2024Primary Adjustm$9.40
03/20/2024 Primary Adjustm 04/12/2024 0 $1,410.00 $0.00 04/12/2024$1,167.91
Claim # 298353 Totals : $2,367.00 $0.00$2,367.00
$9,675.26 $9,675.26 $0.002023 Sub Total: Checking Account Totals:
Checking Account: FA-Guarantee Trust Life Insurance Compan
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
B., Cole; Claim: 298642; Activity: Men's Basketball; Diagnosis: Pain; Anatomy: L-Ankle; Date Incurred: 02/09/2024
03/25/2024 Other Ins Paid 11/12/2024 2330118765 Ochsner Clinic LLC $301.00 10/15/2024$183.01
11/12/2024 2330118765 $45.75 10/15/2024Primary Adjustm$72.24
04/23/2024 Other Ins Paid 11/12/2024 2330118770 Ochsner Clinic LLC $301.00 10/15/2024$183.01
11/12/2024 2330118770 $45.75 10/15/2024Primary Adjustm$72.24
03/06/2024 Primary Adjustm 11/12/2024 2330118769 Ochsner Medical Center $167.00 10/21/2024$101.58
11/12/2024 2330118769 $13.08 10/21/2024Other Ins Paid$52.34
03/08/2024 Primary Adjustm 11/12/2024 2330118763 Ochsner Medical Center $1,408.00 10/21/2024$1,165.91
11/12/2024 2330118763 $48.42 10/21/2024Other Ins Paid$193.67
03/11/2024 Primary Adjustm 11/12/2024 2330118766 Ochsner Medical Center $150.00 10/21/2024$84.58
11/12/2024 2330118766 $13.08 10/21/2024Other Ins Paid$52.34
03/11/2024 Other Ins Paid 11/12/2024 2330118768 Ochsner Clinic LLC $31.00 10/15/2024$18.85
11/12/2024 2330118768 $4.71 10/15/2024Primary Adjustm$7.44
03/11/2024 Other Ins Paid 11/12/2024 2330118762 Ochsner Clinic LLC $488.00 10/15/2024$296.71
11/12/2024 2330118762 $74.17 10/15/2024Primary Adjustm$117.12
03/08/2024 Other Ins Paid 11/12/2024 2330118764 Ochsner Clinic LLC $154.00 10/15/2024$93.63
11/12/2024 2330118764 $23.41 10/15/2024Primary Adjustm$36.96
03/06/2024 Other Ins Paid 11/12/2024 2330118767 Ochsner Clinic LLC $511.00 10/15/2024$297.89
11/12/2024 2330118767 $90.47 10/15/2024Primary Adjustm$122.64
03/06/2024 Primary Adjustm 11/12/2024 2330118761 Ochsner Clinic LLC $25.00 $19.00 10/15/2024$6.00
03/20/2024 Other Ins Paid 04/23/2025 2330129135 Ochsner Medical Center $2,728.00 04/15/2024$200.00
04/23/2025 2330129135 04/15/2024Primary Adjustm$1,384.00
04/23/2025 2330129135 $200.00 04/15/2024Misc. Conversion$944.00
03/20/2024 04/23/2025 2330129137 OccuNet $236.00 $236.00 04/15/2024$0.00
04/01/2024 Other Ins Paid 04/23/2025 2330129134 Ochsner Medical Center $674.00 05/10/2024$50.00
04/23/2025 2330129134 05/10/2024Primary Adjustm$338.00
04/23/2025 2330129134 $50.00 05/10/2024Misc. Conversion$236.00
04/01/2024 04/23/2025 2330129136 OccuNet $59.00 $59.00 05/10/2024$0.00
Claim # 298642 Totals : $7,233.00 $922.84$6,310.16
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
T., John; Claim: 298353; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: R-Hand; Date Incurred: 02/20/2024
04/17/2024 Other Ins Paid 06/17/2024 2330107287 Baton Rouge Orthopaedic Clinic $504.00 05/20/2024$195.08
06/17/2024 2330107287 $55.09 05/20/2024Primary Adjustm$253.83
04/29/2024 Other Ins Paid 06/17/2024 2330107288 Baton Rouge Orthopaedic Clinic $120.00 05/20/2024$35.36
06/17/2024 2330107288 $40.00 05/20/2024Primary Adjustm$44.64
02/26/2024 Other Ins Paid 06/17/2024 2330107289 Ochsner Clinic LLC $358.00 05/20/2024$136.69
06/17/2024 2330107289 $40.00 05/20/2024Primary Adjustm$181.31
04/24/2024 Other Ins Paid 06/17/2024 2330107290 Surgical Specialy Center of Baton Rouge $1,016.00 05/20/2024$196.14
06/17/2024 2330107290 $49.04 05/20/2024Primary Adjustm$770.82
Claim # 298353 Totals : $1,998.00 $184.13$1,813.87
$9,231.00 $8,124.03 $1,106.972023 Sub Total: Checking Account FA-Guarantee Trust Life Ins
Checking Account: GTL
B., Cole; Claim: 298642; Activity: Men's Basketball; Diagnosis: Pain; Anatomy: L-Ankle; Date Incurred: 02/09/2024
03/18/2024 Phys.Therapy Primary Adjustm 09/05/2025 3053867 Ochsner Medical Center $166.00 08/19/2025$92.61
09/05/2025 3053867 $12.83 08/19/2025Disc:Alliance Contract$60.56
03/18/2024 Phys.Therapy Primary Adjustm 09/05/2025 3053867 Ochsner Medical Center $156.00 08/19/2025$87.03
09/05/2025 3053867 $12.06 08/19/2025Disc:Alliance Contract$56.91
03/18/2024 Phys.Therapy Other Ins Paid 09/05/2025 3053867 Ochsner Medical Center $438.00 08/19/2025$50.00
09/05/2025 3053867 08/19/2025Primary Adjustm$244.36
09/05/2025 3053867 $25.11 08/19/2025Disc:Alliance Contract$118.53
03/18/2024 Repricing Fee 09/05/2025 3053873 OccuNet $70.80 $70.80 08/19/2025$0.00
05/03/2024 Phys.Therapy Other Ins Paid 09/16/2025 3054318 Ochsner Medical Center $2,042.00 09/02/2025$150.00
09/16/2025 3054318 09/02/2025Primary Adjustm$962.00
09/16/2025 3054318 $150.00 09/02/2025Disc:OccuNet$780.00
05/03/2024 Repricing Fee 09/16/2025 3054353 OccuNet $234.00 $234.00 09/02/2025$0.00
04/03/2024 Phys.Therapy Other Ins Paid 11/26/2025 3058796 Ochsner Medical Center $4,079.00 11/24/2025$300.00
11/26/2025 3058796 11/24/2025Primary Adjustm$2,063.00
11/26/2025 3058796 $300.00 11/24/2025Disc:OccuNet$1,416.00
04/03/2024 Repricing Fee 11/26/2025 3058810 OccuNet $424.80 $424.80 11/24/2025$0.00
Claim # 298642 Totals : $7,610.60 $1,229.60$6,381.00
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
T., John; Claim: 298353; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: R-Hand; Date Incurred: 02/20/2024
02/26/2024 X-Ray, Radiology Primary Adjustm 11/07/2025 3057254 Ochsner Medical Center $172.00 $65.42 11/04/2025$106.58
Claim # 298353 Totals : $172.00 $65.42$106.58
$7,782.60 $6,487.58 $1,295.022023 Sub Total: Checking Account GTL Totals:
$26,688.86 $2,401.99$24,286.872023 Sub Total: Coverage (FA) BLANKET SPORTS Totals:
Coverage: Not Specified
Checking Account:
A., Hannah; Claim: 293771; Activity: Women's Softball; Diagnosis: Pain; Anatomy: Unspecified; Date Incurred: 10/10/2023
10/11/2023 Ded Credit 10/31/2023 0 $48.57 10/31/2023$48.57
10/31/2023 0 $0.00 10/31/2023Ded Credit$-48.57
10/11/2023 Ded Credit 11/06/2023 0 $29.92 11/06/2023$29.92
11/06/2023 0 $0.00 11/06/2023Ded Credit$-29.92
10/18/2023 Ded Credit 11/06/2023 0 -$9.06 $9.06 11/06/2023$-9.06
10/18/2023 Split Payment 11/06/2023 0 -$9.06 -$9.06 11/06/2023$0.00
10/18/2023 Ded Credit 11/06/2023 0 -$10.92 $10.92 11/06/2023$-10.92
10/18/2023 Split Payment 11/06/2023 0 -$10.92 -$10.92 11/06/2023$0.00
Claim # 293771 Totals : $38.53 $0.00$38.53
C., Tanner; Claim: 299735; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Unspecified; Date Incurred: 03/03/2024
04/16/2024 Primary Adjustm 05/20/2024 0 $320.00 05/20/2024$160.86
05/20/2024 0 $0.00 05/20/2024Ded Credit$159.14
04/22/2024 Primary Adjustm 05/20/2024 0 $1,400.00 05/20/2024$1,144.69
05/20/2024 0 $0.00 05/20/2024Ded Credit$255.31
Claim # 299735 Totals : $1,720.00 $0.00$1,720.00
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
D., Collin; Claim: 295564; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Knee; Date Incurred: 10/27/2023
12/01/2023 Ded Credit 12/26/2023 0 -$141.20 $141.20 12/26/2023$-141.20
12/01/2023 Split Payment 12/26/2023 0 -$141.20 -$141.20 12/26/2023$0.00
12/12/2023 Ded Credit 01/02/2024 0 $55.00 01/02/2024$55.00
01/02/2024 0 $0.00 01/02/2024Ded Credit$-55.00
Claim # 295564 Totals : -$227.40 $0.00-$227.40
J., Allen; Claim: 297362; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Elbow; Date Incurred: 02/02/2024
02/05/2024 Other Ins Paid 02/29/2024 0 $300.00 02/29/2024$94.88
02/29/2024 0 02/29/2024Primary Adjustm$150.12
02/29/2024 0 $0.00 02/29/2024Ded Credit$55.00
02/09/2024 Other Ins Paid 03/07/2024 0 $180.00 03/07/2024$59.83
03/07/2024 0 03/07/2024Primary Adjustm$65.17
03/07/2024 0 $0.00 03/07/2024Ded Credit$55.00
02/08/2024 Other Ins Paid 05/03/2024 0 $695.00 $0.00 05/03/2024$0.00
02/08/2024 Primary Adjustm 05/03/2024 0 $540.17 05/03/2024$540.17
05/03/2024 0 $0.00 05/03/2024Ded Credit$154.83
Claim # 297362 Totals : $1,715.17 $0.00$1,715.17
M., Courtney; Claim: 296688; Activity: Men's Basketball; Diagnosis: Pain; Anatomy: Wrist; Date Incurred: 01/09/2024
01/10/2024 Ded Credit 02/05/2024 0 $358.00 $0.00 02/05/2024$358.00
Claim # 296688 Totals : $358.00 $0.00$358.00
P., Janae; Claim: 294874; Activity: Women's Basketball; Diagnosis: Pain; Anatomy: Shoulder; Date Incurred: 11/06/2023
01/11/2024 Disc:OccuNet 04/02/2024 0 -$701.25 04/02/2024$-701.25
04/02/2024 0 $0.00 04/02/2024Adjustment$1,330.00
05/06/2024 Disc:Zelis Choice 06/07/2024 0 -$1,880.00 06/07/2024$-1,880.00
06/07/2024 0 $0.00 06/07/2024Disc:OccuNet$1,880.00
Claim # 294874 Totals : -$2,581.25 $0.00-$2,581.25
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
R., Scott; Claim: 297914; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Elbow; Date Incurred: 01/30/2024
02/22/2024 Ded Credit 04/01/2024 0 -$409.42 $409.42 04/01/2024$-409.42
02/22/2024 Split Payment 04/01/2024 0 -$409.42 -$409.42 04/01/2024$0.00
02/22/2024 Primary Adjustm 05/29/2024 0 $611.00 05/29/2024$163.13
05/29/2024 0 05/29/2024Disc:OccuNet$111.97
05/29/2024 0 $0.00 05/29/2024Disc:OccuNet$335.90
Claim # 297914 Totals : -$207.84 $0.00-$207.84
R., Madison; Claim: 292652; Activity: Women's Softball; Diagnosis: Pain; Anatomy: Unspecified; Date Incurred: 08/23/2023
09/13/2023 Ded Credit 09/25/2023 0 $400.00 09/25/2023$248.91
09/25/2023 0 09/25/2023Disc:OccuNet$37.77
09/25/2023 0 $0.00 09/25/2023Disc:OccuNet$113.32
09/18/2023 Disc:OccuNet 10/05/2023 0 -$37.77 10/05/2023$-37.77
10/05/2023 0 $0.00 10/05/2023Disc:OccuNet$37.77
09/22/2023 Ded Credit 10/11/2023 0 $200.00 $0.00 10/11/2023$200.00
Claim # 292652 Totals : $562.23 $0.00$562.23
R., Keesley; Claim: 297997; Activity: Women's Softball; Diagnosis: Pain; Anatomy: Back; Date Incurred: 02/05/2024
02/20/2024 Ded Credit 03/25/2024 0 $320.00 $0.00 03/25/2024$320.00
03/05/2024 Ded Credit 04/22/2024 0 $180.00 $0.00 04/22/2024$180.00
Claim # 297997 Totals : $500.00 $0.00$500.00
S., Jaylen; Claim: 296562; Activity: Men's Basketball; Diagnosis: Pain; Anatomy: Wrist; Date Incurred: 01/06/2024
01/14/2024 Ded Credit 02/12/2024 0 -$43.09 $43.09 02/12/2024$-43.09
01/14/2024 Split Payment 02/12/2024 0 -$43.09 -$43.09 02/12/2024$0.00
Claim # 296562 Totals : -$86.18 $0.00-$86.18
$1,791.26 $1,791.26 $0.002023 Sub Total: Checking Account Totals:
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
A., Hannah; Claim: 293771; Activity: Women's Softball; Diagnosis: Pain; Anatomy: Unspecified; Date Incurred: 10/10/2023
10/18/2023 Other Ins Paid 11/13/2023 2330091928 Baton Rouge Orthopaedic Clinic $220.00 11/06/2023$87.55
11/13/2023 2330091928 11/06/2023Primary Adjustm$110.56
11/13/2023 2330091928 $1.91 11/06/2023Ded Credit$19.98
11/02/2023 Other Ins Paid 12/18/2023 2330093969 Baton Rouge Orthopaedic Clinic $220.00 11/27/2023$87.55
12/18/2023 2330093969 $21.89 11/27/2023Primary Adjustm$110.56
10/18/2023 Split Payment 01/04/2024 2330094662 Baton Rouge Orthopaedic Clinic $9.06 $9.06 11/06/2023$0.00
10/11/2023 Other Ins Paid 01/04/2024 2330094664 Baton Rouge Orthopaedic Clinic $500.00 10/31/2023$194.31
01/04/2024 2330094664 $48.57 10/31/2023Primary Adjustm$257.12
10/11/2023 Other Ins Paid 01/04/2024 2330094663 Baton Rouge Orthopaedic Clinic $280.00 11/06/2023$119.67
01/04/2024 2330094663 $29.92 11/06/2023Primary Adjustm$130.41
10/18/2023 Split Payment 01/22/2024 2330095828 Baton Rouge Orthopaedic Clinic $10.92 $10.92 11/06/2023$0.00
11/30/2023 Other Ins Paid 01/22/2024 2330095829 Baton Rouge Orthopaedic Clinic $220.00 12/22/2023$87.55
01/22/2024 2330095829 $21.89 12/22/2023Primary Adjustm$110.56
12/29/2023 Other Ins Paid 02/20/2024 2330097883 Baton Rouge Orthopaedic Clinic $180.00 01/23/2024$64.90
02/20/2024 2330097883 $16.23 01/23/2024Primary Adjustm$98.87
Claim # 293771 Totals : $1,639.98 $160.39$1,479.59
C., Tanner; Claim: 299735; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Unspecified; Date Incurred: 03/03/2024
04/23/2024 Primary Adjustm 06/17/2024 2330107285 Baton Rouge Orthopaedic Clinic $120.00 05/24/2024$38.60
06/17/2024 2330107285 $42.03 05/24/2024Ded Credit$39.37
05/14/2024 Other Ins Paid 06/17/2024 2330107286 Baton Rouge Orthopaedic Clinic $120.00 06/07/2024$46.18
06/17/2024 2330107286 $35.22 06/07/2024Primary Adjustm$38.60
Claim # 299735 Totals : $240.00 $77.25$162.75
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
D., Collin; Claim: 295564; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Knee; Date Incurred: 10/27/2023
12/21/2023 Other Ins Paid 02/02/2024 2330096807 Peak Performance Physical Therapy $1,823.00 01/18/2024$335.02
02/02/2024 2330096807 $220.00 01/18/2024Primary Adjustm$1,267.98
12/18/2023 Primary Adjustm 02/02/2024 2330096808 Baton Rouge Orthopaedic Clinic $2,950.00 $840.54 01/16/2024$2,109.46
12/01/2023 Primary Adjustm 02/02/2024 2330096806 Baton Rouge Orthopaedic Clinic $1,400.00 12/26/2023$1,132.02
02/02/2024 2330096806 12/26/2023Ded Credit$267.98
02/02/2024 2330096806 $181.78 12/26/2023Misc. Conversion$-181.78
12/18/2023 Other Ins Paid 02/21/2024 2330098023 Lake Surgery Center $6,739.00 01/29/2024$1,874.39
02/21/2024 2330098023 $150.00 01/29/2024Primary Adjustm$4,714.61
12/01/2023 Split Payment 02/21/2024 2330098024 Baton Rouge Orthopaedic Clinic $141.20 $141.20 12/26/2023$0.00
12/12/2023 Other Ins Paid 05/09/2024 2330104189 Baton Rouge Orthopaedic Clinic $120.00 01/02/2024$23.78
05/09/2024 2330104189 $55.00 01/02/2024Primary Adjustm$41.22
02/12/2024 Other Ins Paid 05/09/2024 2330104190 Baton Rouge Orthopaedic Clinic $1,930.00 03/07/2024$662.34
05/09/2024 2330104190 $55.00 03/07/2024Primary Adjustm$1,212.66
05/07/2024 Adjustment 05/09/2024 2330104188 Baton Rouge Orthopaedic Clinic $0.00 $0.00 05/07/2024$1.14
Claim # 295564 Totals : $15,103.20 $1,643.52$13,459.68
J., Allen; Claim: 297362; Activity: Men's Baseball; Diagnosis: Pain; Anatomy: Elbow; Date Incurred: 02/02/2024
02/08/2024 Other Ins Paid 06/27/2024 2330108157 Surgical Specialy Center of Baton Rouge $611.00 04/29/2024$40.97
06/27/2024 2330108157 04/29/2024Primary Adjustm$163.13
06/27/2024 2330108157 $367.41 04/29/2024Misc. Conversion$39.49
02/08/2024 Adjustment 06/27/2024 2330108158 Surgical Specialy Center of Baton Rouge $0.00 $0.00 06/25/2024$1.57
Claim # 297362 Totals : $611.00 $367.41$243.59
M., Courtney; Claim: 296688; Activity: Men's Basketball; Diagnosis: Pain; Anatomy: Wrist; Date Incurred: 01/09/2024
01/10/2024 Ded Credit 02/28/2025 2330125387 Ochsner Medical Center $172.00 $30.00 02/21/2025$142.00
Claim # 296688 Totals : $172.00 $30.00$142.00
Report Criteria:
6/29/2026 4:34:24 PM
Pay Dates: 01/01/1900 - 06/29/2026 Claims History Report
Service
Date
Payee Name Coverage Amount Claimed Reduction
Amount
Reduction Reason Amount Paid Date
Received
Check Date Check
Number
P., Janae; Claim: 294874; Activity: Women's Basketball; Diagnosis: Pain; Anatomy: Shoulder; Date Incurred: 11/06/2023
11/21/2023 Disc:OccuNet 01/05/2024 2330094727 Baton Rouge Orthopaedic Clinic $250.00 $184.14 12/08/2023$65.86
12/05/2023 Disc:OccuNet 01/05/2024 2330094726 Baton Rouge Orthopaedic Clinic $280.00 $80.24 12/14/2023$199.76
12/05/2023 Disc:OccuNet 01/05/2024 2330094728 Baton Rouge Orthopaedic Clinic $140.00 $123.20 12/11/2023$16.80
11/13/2023 01/05/2024 2330094724 OccuNet $493.38 $493.38 11/29/2023$0.00
11/13/2023 Disc:OccuNet 01/05/2024 2330094725 Baton Rouge Orthopaedic Clinic $2,200.00 11/29/2023$493.38
01/05/2024 2330094725 $389.37 11/29/2023Disc:OccuNet$1,317.25
11/07/2023 Disc:OccuNet 02/01/2024 2330096690 Baton Rouge Orthopaedic Clinic $400.00 01/19/2024$37.77
02/01/2024 2330096690 $248.91 01/19/2024Disc:OccuNet$113.32
11/07/2023 02/01/2024 2330096691 OccuNet $37.77 $37.77 01/19/2024$0.00
12/29/2023 Disc:OccuNet 02/05/2024 2330096899 OccuNet $980.00 $245.00 01/05/2024$735.00
12/29/2023 Ded Credit 02/05/2024 2330096901 Baton Rouge Orthopaedic Clinic $4,900.00 01/05/2024$500.00
02/05/2024 2330096901 01/05/2024Disc:OccuNet$837.91
02/05/2024 2330096901 $1,048.35 01/05/2024Disc:OccuNet$2,513.74
12/29/2023 02/05/2024 2330096900 OccuNet $837.91 $837.91 01/05/2024$0.00
01/11/2024 Disc:OccuNet 03/07/2024 2330099375 Baton Rouge Orthopaedic Clinic $1,975.00 01/29/2024$350.00
03/07/2024 2330099375 $575.00 01/29/2024Disc:OccuNet$1,050.00
01/11/2024 03/07/2024 2330099376 OccuNet $350.00 $350.00 01/29/2024$0.00
04/02/2024 0 $0.00 -$233.75 04/02/2024$0.00
01/11/2024 05/22/2024 2330105233 OccuNet $233.75 $233.75 04/02/2024$0.00
03/01/2024 05/22/2024 2330105228 OccuNet $151.25 $151.25 04/02/2024$0.00
01/11/2024 Disc:OccuNet 05/22/2024 2330105231 Baton Rouge Orthopaedic Clinic $1,330.00 04/02/2024$233.75
05/22/2024 2330105231 $395.00 04/02/2024Disc:OccuNet$701.25
02/05/2024 Disc:OccuNet 05/22/2024 2330105232 Baton Rouge Orthopaedic Clinic $1,910.00 04/02/2024$342.50
05/22/2024 2330105232 $540.00 04/02/2024Disc:OccuNet$1,027.50
02/05/2024 05/22/2024 2330105229 OccuNet $342.50 $342.50 04/02/2024$0.00
03/01/2024 Disc:OccuNet 05/22/2024 2330105230 Baton Rouge Orthopaedic Clinic $875.00 04/02/2024$151.25
05/22/2024 2330105230 $270.00 04/02/2024Disc:OccuNet$453.75
05/20/2024 Adjustment 05/22/2024 2330105226 Baton Rouge Orthopaedic Clinic $0.00…
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