This is a letter to a patient stating that we participate in their HMO. This is a letter to a patient to find out if the patient has health insurance. This could also be used for commercial insurance. This is a letter informing the patient that the medical provider does not participate in insurance plans or HMO groups and that there is interest on any unpaid balance.
This is a letter to a patient stating that we participate in their HMO.
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
A claim form has been filed with your HMO carrier. Provided the carrier pays in accordance with teh provisions of the policy, payment will be accepted as payment in full.
You will be expected to follow up on all unpaid claims.
This is a letter to a patient to find out if the patient has health insurance. This could also be used for 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
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. **
If you have health insurance, please obtain the proper form from your agent or employer. We would appreciate your enclosing payment when sending us your form.
We would like to point out that the type of coverage you have does not affect the fee charged. If you have any questions or problems, please call our office.
This is a letter informing the patient that the medical provider does not participate in insurance plans or HMO groups and that there is interest on any unpaid balance.
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.
If you have health insurance, please obtain the proper form from your agent or employer. We would appreciate your enclosing payment when sending us your form.
We would like to point out that the type of coverage you have does not affect the fee charged. If you do have any questions or problems, please call our office.
This office does not participate in any insurance plans or HMO groups. You are responsible for payment – your insurance company is responsible to you.
6 ½% Interest will be charged on any unpaid balance after 6 months.
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