2.2_Deductible_PartB_120907.pdf

Page 1 of 5Medicare Summary Noticefor Part B (Medical Insurance)The Official Summary of Your Medicare Claims from the Centers for Medicare & Medicaid ServicesYour Deductible StatusYour deductible is what you must pay for most health services before Medicare begins to pay. Part B Deductible: You have now met your $162.00  deductible for 2010. Be Informed!Register at www.MyMedicare.gov for direct access to your Original Medicare claims, track your preventive services and print an On the Go report to share with your provider. Visit the Web site to sign up and access your personal Medicare information.THIS IS NOT A BILLJENNIFER WASHINGTON  TEMPORARY ADDRESS NAMESTREET ADDRESSCITY, ST 12345-6789Your Claims & Costs This PeriodDid Medicare Approve All Claims? NONumber of Services Medicare Denied 2See claims starting on page 3. Look for NO in the Service Approved? column. See the last page for how to handle a denied claim. Total You May Be Billed $150.86Providers with Claims This PeriodJune 18, 2011  Susan Jones, M.D.June 28, 2011  Craig I. Secosan, M.D. June 29  June 30, 2011  Edward J. Mcginley M.D. Saba que puede recibir este aviso y otro tipo de ayuda de Medicare en espaol? Llame y hable con un agente en espaol.     agent ,  Mandarin .                   1-800-MEDICARE (1-800-633-4227)Notice for Jennifer WashingtonMedicare Number XXX-XX-1234ADate of This Notice September 16, 2011Claims Processed  BetweenJune 15   September 15, 2011Exhibit 2.2a  Part B Deductible: Single MetMedicare Summary Noticefor Part B (Medical Insurance)The Official Summary of Your Medicare Claims from the Centers for Medicare & Medicaid ServicesYour Deductible StatusYour deductible is what you must pay for most health services before Medicare begins to pay. Part B Deductible: You have now met your $162.00 deductible for 2010. You have now met $85.00  of your $162.00  deductible for 2011. Be Informed!Register at www.MyMedicare.gov for direct access to your Original Medicare claims, track your preventive services and print an On the Go report to share with your provider. Visit the Web site to sign up and access your personal Medicare information.THIS IS NOT A BILLJENNIFER WASHINGTON  TEMPORARY ADDRESS NAMESTREET ADDRESSCITY, ST 12345-6789Your Claims & Costs This PeriodDid Medicare Approve All Claims? NONumber of Services Medicare Denied 2See claims starting on page 3. Look for NO in the Service Approved? column. See the last page for how to handle a denied claim. Total You May Be Billed $150.86Providers with Claims This PeriodJune 18, 2011  Susan Jones, M.D.June 28, 2011  Craig I. Secosan, M.D. June 29  June 30, 2011  Edward J. Mcginley M.D. Saba que puede recibir este aviso y otro tipo de ayuda de Medicare en espaol? Llame y hable con un agente en espaol.     agent ,  Mandarin .                   1-800-MEDICARE (1-800-633-4227)Page 1 of 5Notice for Jennifer WashingtonMedicare Number XXX-XX-1234ADate of This Notice September 16, 2011Claims Processed  BetweenJune 15   September 15, 2011Exhibit 2.2b  Part B Deductible: Met and UnmetMedicare Summary Noticefor Part B (Medical Insurance)The Official Summary of Your Medicare Claims from the Centers for Medicare & Medicaid ServicesYour Deductible StatusYour deductible is what you must pay for most health services before Medicare begins to pay. Part B Deductible: You have now met your $162.00 deductible for 2008. You have now met your $162.00 deductible for 2009. You have now met $62.00  of your $162.00  deductible for 2011.Be Informed!Register at www.MyMedicare.gov for direct access to your Original Medicare claims, track your preventive services and print an On the Go report to share with your provider. Visit the Web site to sign up and access your personal Medicare information.THIS IS NOT A BILLJENNIFER WASHINGTON  TEMPORARY ADDRESS NAMESTREET ADDRESSCITY, ST 12345-6789Your Claims & Costs This PeriodDid Medicare Approve All Claims? NONumber of Services Medicare Denied 2See claims starting on page 3. Look for NO in the Service Approved? column. See the last page for how to handle a denied claim. Total You May Be Billed $150.86Providers with Claims This PeriodJune 18, 2011  Susan Jones, M.D.June 28, 2011  Craig I. Secosan, M.D. June 29  June 30, 2011  Edward J. Mcginley M.D. Saba que puede recibir este aviso y otro tipo de ayuda de Medicare en espaol? Llame y hable con un agente en espaol.     agent ,  Mandarin .                   1-800-MEDICARE (1-800-633-4227)Page 1 of 5Notice for Jennifer WashingtonMedicare Number XXX-XX-1234ADate of This Notice September 16, 2011Claims Processed  BetweenJune 15   September 15, 2011Exhibit 2.2c  Part B Deductible: Multiple Met and Unmet