The following letter is to notify the patient that we filed to Blue Shield. This is a letter to a patient with commercial insurance. This letter is to a patient who was seen at a specific hospital and this letter addresses their Medicare policies.
The following letter is to notify the patient 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
Payment due upon receipt of this bill.
The enclosed Blue Shield Form is to be completed and returned to our office promptly for processing.
If you have major medical or other insurance coverage, send a fully completed form, assigned to pay the doctor directly.
We will bill you for any balance due after your insurance has paid. Thank you.
This is a letter to a patient with commercial insurance.
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
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
Payment is requested upon receipt of this statement.
Professional services are rendered to you, not to the insurance company. You are directly responsible for the payment of this bill.
As a courtesy to our patients, we will complete and file all insurance forms if you provide the following:
An insurance claim form from your agent or employer with an assignment of benefits to pay the doctor directly.
The address of your insurance carrier to which claims must be sent for processing.
You will be billed for any balance not paid by insurance.
This letter is to a patient who was seen at a specific hospital and this letter addresses their Medicare policies.
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
* Payment is requested upon receipt of this statement. *
Professional services are rendered to you, not to the insurance company. You are directly responsible for payment of this bill.
As a courtesy to our patients, we will complete and file your Medicare form on a non-assigned basis. Thus, Medicare will remit directly to you. Please advise our office if you have additional major medical insurance.
If you have any problems or need assistance, please call our office.
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