This is a letter to a patient where it is an endo private account and we have the form. I believe this is referring to Endo Pharmaceuticals Holdings Inc. This is a letter to a doctor with private patients letting them know that the doctor will accept the insurance as payment in full. This is a letter to a patient letting them know that we filed to Blue Shield.
This is a letter to a patient where it is an endo private account and we have the form. I believe this is referring to Endo Pharmaceuticals Holdings Inc.
Account # MA 8674
INCLUDE YOUR ACCOUNT # ON ALL CORRESPONDENCE
Jill Bennett, M.D. PC 08/02/2010
P.O. BOX 2759
Islip, NY 11751
800-828-2837 / 631-158-6030 Phone Hrs: Mon-Fri 10 AM To 1 PM
Richard/Marion Hall
35 Dover Lane
Bay Shore, NY 11706
For anesthesia or related services at Good Samaritan Medical Center
1000 Montauk Highway, West Islip, NY 11795
To Marion Hall On 07/06/2010 Amount $1,615.00
Payments received to date $1,502.40
Balance Due $112.60
Your insurance form has been filed. We are accepting your insurance company’s determination as payment in full. If you have not met your deductible you will be responsible for the deductible amount.
If you have coverage other than or in addition to the form we are now filing, please send us a completed form and an address for filing.
Payment should be assigned to the doctor directly.
Thank you for your assistance and cooperation.
This is a letter to a doctor with private patients letting them know that the doctor will accept the insurance as payment in full.
Account # MA 8674
INCLUDE YOUR ACCOUNT # ON ALL CORRESPONDENCE
Jill Bennett, M.D. PC 08/02/2010
P.O. BOX 2759
Islip, NY 11751
800-828-2837 / 631-158-6030 Phone Hrs: Mon-Fri 10 AM To 1 PM
Richard/Marion Hall
35 Dover Lane
Bay Shore, NY 11706
For anesthesia or related services at Good Samaritan Medical Center
1000 Montauk Highway, West Islip, NY 11795
To Marion Hall On 07/06/2010 Amount $1,615.00
Payments received to date $1,502.40
Balance Due $112.60
Your insurance will be accepted as full payment. If we feel a review is required, we shall expect you to cooperate by contacting your insurance carrier to verify that payment has been made in accordance with your policy provisions.
Please send us a completed assigned form and indicate the address to send it to. You will be billed for any deductible you have not met. certain pain doctor’s private patients.
This is a letter to a patient letting them know that we filed to Blue Shield.
Account # MA 8674
INCLUDE YOUR ACCOUNT # ON ALL CORRESPONDENCE
Jill Bennett, M.D. PC 08/02/2010
P.O. BOX 2759
Islip, NY 11751
800-828-2837 / 631-158-6030 Phone Hrs: Mon-Fri 10 AM To 1 PM
Richard/Marion Hall
35 Dover Lane
Bay Shore, NY 11706
For anesthesia or related services at Good Samaritan Medical Center
1000 Montauk Highway, West Islip, NY 11795
To Marion Hall On 07/06/2010 Amount $1,615.00
Payments received to date $1,502.40
Balance Due $112.60
Your insurance will be accepted as full payment. If we feel a review is required, we shall expect you to cooperate by contacting your insurance carrier to verify that payment has been made in accordance with your policy provisions.
Please send us a completed assigned form and indicate the address to send it to. You will be billed for any deductible you have not met.
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