evekhm/cms_iom_500 huggingface dataset:
2.6_Multipledates_120511.pdf
Service Provided & Billing CodeService  Approved?Amount  Provider  ChargedMedicare-  Approved  AmountAmount  Medicare  PaidMaximum  You May  Be BilledSee  Notes  BelowNovember 18, 2011Physical therapy evaluation  (97001-GP)Yes $100.00 $78.83 $63.06 $15.77 AApplication of hot or cold packs to 1 or more areas (97010-GP)Yes 10.00 10.00 8.00 2.00 ATherapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes  (97112-GP)Yes 60.00 33.31 26.65 6.66 ATherapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes (97110-GP)Yes 50.00 32.00 25.60 6.40 ANovember 20, 2011Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes  (97112-GP)Yes 60.00 33.31 26.65 6.66 ATherapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes (97110-GP)Yes 50.00 32.00 25.60 6.40 ATotal for Claim #83-11011-003-050 $50.00 $219.45 $175.56 $43.89November 18  November 20, 2011Dr. Jaagosild, Priit M.D., (555) 555-1234 Arnette Clinic, LLC, 8016 Reliable Pkwy, Chicago, IL 60686-0001  Referredy by Dupre, Gary WExhibit 2.6a  Part B multiple datesService Provided & Billing CodeService  Approved?Amount  Provider  ChargedMedicare-  Approved  AmountAmountMedicare  PaidMaximum  You May  Be BilledSee  Notes  BelowDecember 9, 2010Hospital inpatient care (99233) Yes $116.00 $106.18 $84.94 $21.24 ADecember 10, 2010Hospital inpatient care (99232) Yes 81.00 73.85 59.08 14.77 ADecember 10  December 12, 2010Hospital inpatient care (99232) Yes 81.00 73.85 59.08 14.77 ADecember 12, 2010Hospital inpatient care (99232) Yes
2.6_Multipledates_120511.pdf
14.77 ADecember 10  December 12, 2010Hospital inpatient care (99232) Yes 81.00 73.85 59.08 14.77 ADecember 12, 2010Hospital inpatient care (99232) Yes 81.00 73.85 59.08 14.77 ADecember 13, 2010Hospital discharge (99239) Yes 140.00 106.69 85.35 21.34 ATotal for Claim #02-10204-674-840 $499.00 $434.42 $347.53 $86.89December 9  December 13, 2011Bruce A. Lief, M.D., (555) 555-1234  2701 Holme Ave, Philadelphia, PA 19152-0000  Referred by Roy K AugusthyExhibit 2.6b  Part B multiple datesService Provided & Billing CodeService  Approved?Amount  Provider  ChargedMedicare-  Approved  AmountAmountMedicare  PaidMaximum  You May  Be BilledSee  Notes  BelowDr. Kevin W. BrownXray of chest, 2 views, front and side professional charge (71020-26)Yes $50.00 $12.07 $9.66 $2.41 AApplication of hot or cold packs to 1 or more areas (97010-GP)Yes 10.00 10.00 8.00 2.00 ADr. Jeffrey C. Pan, M.D.Ultrasound scan of veins of both arms or legs including assessment of compression and functional man (93970-26)Yes 174.00 37.76 30.21 7.55 ATotal for Claim #18-10209-086-660 $234.00 $59.83 $47.87 $11.96Service Provided & Billing CodeService  Approved?Amount  Provider  ChargedMedicare-  Approved  AmountAmountMedicare  PaidMaximum  You May  Be BilledSee  Notes  BelowJuly 14, 2011/Dr. Kevin W. BrownXray of chest, 2 views, front and side professional charge (71020-26)Yes $50.00 $12.07 $9.66 $2.41 AJuly 15, 2011/Dr. Jeffrey C. Pan, M.D.Ultrasound scan of veins of both arms or legs including assessment of compression and functional man (93970-26)Yes 174.00 37.76 30.21 7.55 AJuly
2.6_Multipledates_120511.pdf
Jeffrey C. Pan, M.D.Ultrasound scan of veins of both arms or legs including assessment of compression and functional man (93970-26)Yes 174.00 37.76 30.21 7.55 AJuly 16, 2011/Dr. Kevin W. BrownXray of chest, 2 views, front and side professional charge (71020-26)Yes 50.00 12.07 9.66 2.41 AApplication of hot or cold packs to 1 or more areas (97010-GP)Yes 10.00 10.00 8.00 2.00 ATotal for Claim #18-10209-086-663 $284.00 $71.90 $57.53 $14.37July 13, 2011Rad Group of Abington, (555) 555-1234  PO Box 10668, Lancaster, PA 17605-0668  Referred by Dr. Christoph K. Blazes, M.D.July 14  July 16, 2011Rad Group of Abington, (555) 555-1234  PO Box 10668, Lancaster, PA 17605-0668  Referred by Dr. Christoph K. Blazes, M.D.Exhibit 2.6c  Part B multiple providers/datesQuantity, Item/Service Provided  & Billing CodeItem/  Service  Approved?Amount  Supplier  ChargedMedicare-  Approved  AmountAmount  Medicare  PaidMaximum  You May  Be BilledSee  Notes  BelowJune 9, 20102 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concen (E1390-RR) RentalYes $459.68 $173.17 $138.54 $34.63 A2 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concen (E1390-RR) RentalYes 122.31 28.77 23.02 5.75 AJuly 9, 20102 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concen (E1390-RR) RentalYes 459.68 173.17 138.54 34.63 A2 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concen (E1390-RR) RentalYes 122.31 28.77 23.02 5.75 AAugust 9, 20102 Oxygen concentrator, single delivery port, capable of
2.6_Multipledates_120511.pdf
port, capable of delivering 85 percent or greater oxygen concen (E1390-RR) RentalYes 122.31 28.77 23.02 5.75 AAugust 9, 20102 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concen (E1390-RR) RentalYes 459.68 173.17 138.54 34.63 A2 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concen (E1390-RR) RentalYes 122.31 28.77 23.02 5.75 ATotal for Claim #02-10204-674-860 $1,745.97 $605.82 $484.68 $121.14June 9  August 9, 2011Lincare Inc., (555) 555-1234  PO BOX 996, Blue Springs, MO 64013-0996  Referred by John K WhalenExhibit 2.6d  DME Multiple Dates
2.7_NoneRemain_120409.pdf
Benefit  Days  UsedClaim  Approved?Non-  Covered  ChargesAmount  Medicare  PaidMaximum  You May  Be BilledSee  Notes  BelowBenefit Period starting Oct. 2, 2011 none  remainNO $480,579.03 $0.00 $480,579.30Total for Claim #21036201645104ILA $480,579.03 $0.00 $480,579.30 AJennifer Washington THIS IS NOT A BILL | Page 3 of 5Part A Inpatient Hospital Insurance helps pay for inpatient hospital care, inpatient care in a skilled nursing facility following a hospital stay, home health care, and hospice care. Definitions of ColumnsBenefit Days Used: The number of covered benefit days you used during each hospital and/or skilled nursing facility stay. (See page 2 for more information and a summary of your benefit periods.)  Claim Approved?: This column tells you if Medicare covered the inpatient stay.  Non-Covered Charges: This is the amount Medicare didnt pay. Amount Medicare Paid: This is the amount Medicare paid your inpatient facility.Maximum You May Be Billed: The amount you may be billed for Part A services can include a deductible, coinsurance based on your benefit days used, and other charges. For more information about Medicare Part A coverage, see your Medicare & You handbook.Your Inpatient Claims for Part A (Hospital Insurance)November 9  December 21, 2011Swedish Covenant Hospital, (555) 555-1234  5145n California Ave, Chicago, IL 60640-4213Referred by Ermias TilahunContinued   Notes for Claims AboveAYou have used all of your benefit days for this period.Exhibit 2.7  Part A None-Remian Benefit Days
2.8_AdjustedClaim_120925.pdf
Service Provided & Billing CodeService  Approved?Amount  Provider  ChargedMedicare-  Approved  AmountAmount  Medicare  PaidMaximum  You May  Be BilledSee  Notes  BelowUltrasonic guidance for placement of needle (76942-26)Yes   adjusted$95.00 $95.00 $76.00 $19.00Ultrasonic guidance for placement of needle (76942-26)Yes   adjusted95.00 35.81 28.65 7.16Ultrasonic guidance for placement of needle (76942-26)Yes   adjusted95.00 35.81 28.65 7.16Total for Claim #02-10195-592-700 $285.00 $166.62 $133.30 $33.32 A,BJennifer Washington THIS IS NOT A BILL | Page 3 of 5Part B Medical Insurance helps pay for doctors services, diagnostic tests, ambulance services, and other health care services. Definitions of ColumnsService Approved? : This column tells you if Medicare covered this service. Amount Provider Charged : This is your providers fee for this service. Medicare-Approved Amount : This is the amount a provider can be paid for a Medicare service. It may be less than the actual amount the provider charged.Your provider has agreed to accept this amount as full payment for covered services. Medicare usually pays 80% of the Medicare-approved amount.Amount Medicare Paid : This is the amount Medicare paid your provider. This is usually 80% of the Medicare-approved amount. Maximum You May Be Billed : This is the total amount the provider is allowed to bill you, and can include a deductible, coinsurance, and other charges not covered. If you have Medicare Supplement Insurance (Medigap policy) or other insurance, it may pay all or part of this amount. Your Claims for Part B (Medical Insurance)October 13, 2010Samuel G. Putnam M.D., (555) 555-1234  Univ of Penn  Comm Rad, 999 Old Eagle School Road, Suite 118, Wayne, PA 19087-1707  Referred by David G NazarianContinued   Notes for Claims AboveAYour claim was sent to your Medicare Supplement Insurance (Medigap policy), Wellmark BlueCross BlueShield of N. Carolina. Send any questions regarding your benefits to them. BThis is an adjustment to a previously processed claim and/or deductible record.Exhibit
2.8_AdjustedClaim_120925.pdf
Supplement Insurance (Medigap policy), Wellmark BlueCross BlueShield of N. Carolina. Send any questions regarding your benefits to them. BThis is an adjustment to a previously processed claim and/or deductible record.Exhibit 2.8  Adjusted Claim
2.9_ContinuedClaims_120409.pdf
Service Provided & Billing CodeService  Approved?Amount  Provider  ChargedMedicare-  Approved  AmountAmount  Medicare  PaidMaximum  You May  Be BilledSee  Notes  BelowEmergency department visit (99285)Yes $434.00 $156.91 $125.53 $31.38Interpretation and report of electrical activity of heart using 1-3 leads (93042)Yes 39.00 7.32 5.86 1.4612-Lead ECG performed (3120F) Yes 0.00 0.00 0.00 0.00 ATotal for Claim #11-10203-914-840 $473.00 $164.23 $131.39 $32.84Jennifer Washington THIS IS NOT A BILL | Page 3 of 5Part B Medical Insurance helps pay for doctors services, diagnostic tests, ambulance services, and other health care services. Definitions of ColumnsService Approved? : This column tells you if Medicare covered this service. Amount Provider Charged : This is your providers fee for this service. Medicare-Approved Amount : This is the amount a provider can be paid for a Medicare service. It may be less than the actual amount the provider charged.Your provider has agreed to accept this amount as full payment for covered services. Medicare usually pays 80% of the Medicare-approved amount.Amount Medicare Paid : This is the amount Medicare paid your provider. This is usually 80% of the Medicare-approved amount. Maximum You May Be Billed : This is the total amount the provider is allowed to bill you, and can include a deductible, coinsurance, and other charges not covered. If you have Medicare Supplement Insurance (Medigap policy) or other insurance, it may pay all or part of this amount. Your Claims for Part B (Medical Insurance)July 13, 2011Teresa Lim, M.D., (555) 555-1234 Abington Emergency Phys, PO Box 3012, Wilmington, DE 19804-0012Continued   Notes for Claims AboveAThis code is for informational/reporting purposes only. You should not be charged for this code. If there is a charge, you do not have to pay the amount.Exhibit 2.9  Continued Claims with Continuation BoxService Provided & Billing CodeService  Approved?Amount  Provider  ChargedMedicare-  Approved  AmountAmount  Medicare  PaidMaximum  You May  Be BilledSee  Notes  BelowEmergency department visit (99285)Yes
2.9_ContinuedClaims_120409.pdf
 Continued Claims with Continuation BoxService Provided & Billing CodeService  Approved?Amount  Provider  ChargedMedicare-  Approved  AmountAmount  Medicare  PaidMaximum  You May  Be BilledSee  Notes  BelowEmergency department visit (99285)Yes $434.00 $184.60 $147.68 $36.92Total for Claim #11-10211-819-140 $434.00 $184.60 $147.68 $36.92Service Provided & Billing CodeService  Approved?Amount  Provider  ChargedMedicare-  Approved  AmountAmount  Medicare  PaidMaximum  You May  Be BilledSee  Notes  BelowEmergency department visit (99285)Yes $434.00 $184.60 $147.68 $36.92Total for Claim #11-10217-667-100 $434.00 $184.60 $147.68 $36.92Service Provided & Billing CodeService  Approved?Amount  Provider  ChargedMedicare-  Approved  AmountAmount  Medicare  PaidMaximum  You May  Be BilledSee  Notes  BelowEmergency department visit (99285)Yes $434.00 $184.60 $147.68 $36.9212-Lead ECG performed (3120F) Yes 0.00 0.00 0.00 0.00 BTotal for Claim #11-10211-818-070 $434.00 $184.60 $147.68 $36.92Jennifer Washington THIS IS NOT A BILL | Page 4 of 5July 23, 2011Dr. Thomas F. Harkins, M.D., (555) 555-1234 Abington Emergency Phys, PO Box 3012, Wilmington, DE 19804-0012July 25, 2011Dr. Bruce D. Rubin, M.D., (555) 555-1234 Abington Emergency Phys, PO Box 3012, Wilmington, DE 19804-0012July 27, 2011Dr. Philippe A. Kerillis, DO, (555) 555-1234 Abington Emergency Phys, PO Box 3012, Wilmington, DE 19804-0012Continued   Notes for Claims AboveBThis code is for informational/reporting purposes only. You should not be charged for this ode. If there is a charge, you do not have to pay the amount.Exhibit 2.9  Continued Claims with Continuation BoxService Provided & Billing
2.9_ContinuedClaims_120409.pdf
code is for informational/reporting purposes only. You should not be charged for this ode. If there is a charge, you do not have to pay the amount.Exhibit 2.9  Continued Claims with Continuation BoxService Provided & Billing CodeService  Approved?Amount  Provider  ChargedMedicare-  Approved  AmountAmount  Medicare  PaidMaximum  You May  Be BilledSee  Notes  BelowPhysician nursing facility visit (99309)Yes $122.00 $89.15 $71.32 $17.83Total for Claim #11-10219-819-150 $122.00 $89.15 $71.32 $17.83Service Provided & Billing CodeService  Approved?Amount  Provider  ChargedMedicare-  Approved  AmountAmount  Medicare  PaidMaximum  You May  Be BilledSee  Notes  BelowPhysician nursing facility visit (99308)Yes $93.00 $57.70 $31.74 $25.96 DTotal for Claim #11-10219-828-850 $93.00 $57.70 $31.74 $25.96Service Provided & Billing CodeService  Approved?Amount  Provider  ChargedMedicare-  Approved  AmountAmount  Medicare  PaidMaximum  You May  Be BilledSee  Notes  BelowEmergency department visit (99285)Yes $434.00 $184.60 $147.68 $36.9212-Lead ECG performed (3120F) Yes 0.00 0.00 0.00 0.00 CTotal for Claim #11-10218-818-072 $434.00 $184.60 $147.68 $36.92Jennifer Washington THIS IS NOT A BILL | Page 5 of 5August 17, 2011Dr. Steven F. Fisher, M.D., (555) 555-1234 Abington Emergency Phys, PO Box 3012, Wilmington, DE 19804-0012August 22, 2011Cynthia G. Pyle, NP, (555) 555-1234 Abington Memorial Hospital, PO Box 786311, Philadelphia, PA 19178-6311  Referred by Dr. Jennifer O. Orr, M.D.August 19, 2010Dr. Larry S. Keller, DO, (555) 555-1234 Abington Memorial Hospital, PO Box 786311, Philadelphia, PA 19178-6311Notes for Claims AboveCThis code is for informational/reporting purposes
2.9_ContinuedClaims_120409.pdf
Larry S. Keller, DO, (555) 555-1234 Abington Memorial Hospital, PO Box 786311, Philadelphia, PA 19178-6311Notes for Claims AboveCThis code is for informational/reporting purposes only. You should not be charged for this ode. If there is a charge, you do not have to pay the amount.DOutpatient mental health services are paid at 55% of the approved amount.Exhibit 2.9  Continued Claims with Continuation Box
3.10_SP_Duplicate_120907.pdf
Resumen de Medicarepara la Parte B (Seguro Mdico) El resumen oficial de los Centros de Servicios de Medicare y Medicaid  sobre sus reclamaciones a MedicarePgina 1 de 5Su deducibleEl deducible es la cantidad que usted tiene que pagar por la mayora de los servicios mdicos antes de que Medicare comience a pagar.Deducible de la Parte B:  Usted ha pagado $85.00  de su deducible de $162.00  para el 2011.Infrmese!Inscrbase en www.MiMedicare.gov para tener acceso directo a las reclamaciones del Medicare Original, hacer un seguimiento de sus servicios preventivos e imprimir el Informe Inmediato para compartirlo con sus proveedores. Visite el sitio Web para registrarse y acceder a su informacin personal de Medicare.COPIA DUPLICADAEsta No Es Una FacturaANDREA TORRES  TEMPORARY ADDRESS NAME  STREET ADDRESSCITY, ST 12345-6789Proveedores con reclamaciones durante este perodo18 de junio de 2011  Susan Jones, M.D.28 de junio de 2011  Craig I. Secosan, M.D. 29 de junio  30 de junio de 2011  Edward J. Mcginley M.D. Sus reclamaciones y costos en este perodoAprob Medicare todos los servicios? NOServicios denegados 2Vea la pgina 3 para ver las reclamaciones.  Fjese en la columna Fue aprobado el servicio? se indique NO. Para saber qu hacer con las reclamaciones denegadas, vea la ltima pgina.El total que le pueden facturar $150.86Aviso para Andrea TorresNmero de Medicare XXX-XX-1234AFecha de este aviso 16 de septiembre de 2011Reclamacin  procesada entre15 de junio  15 de septiembre de 2011  Exhibit 3.10  Spanish Duplicate
3.11_SP_Deductible_PartB_120907.pdf
Resumen de Medicarepara la Parte B (Seguro Mdico) El resumen oficial de los Centros de Servicios de Medicare y Medicaid  sobre sus reclamaciones a MedicarePgina 1 de 5Su deducibleEl deducible es la cantidad que usted tiene que pagar por la mayora de los servicios mdicos antes de que Medicare comience a pagar.Deducible de la Parte B:  Usted ha pagado su deducible de $162.00  para el 2011.Infrmese!Inscrbase en www.MiMedicare.gov para tener acceso directo a las reclamaciones del Medicare Original, hacer un seguimiento de sus servicios preventivos e imprimir el Informe Inmediato para compartirlo con sus proveedores. Visite el sitio Web para registrarse y acceder a su informacin personal de Medicare.ESTA NO ES UNA FACTURAANDREA TORRES  TEMPORARY ADDRESS NAME  STREET ADDRESSCITY, ST 12345-6789Proveedores con reclamaciones durante este perodo18 de junio de 2011  Susan Jones, M.D.28 de junio de 2011  Craig I. Secosan, M.D. 29 de junio  30 de junio de 2011  Edward J. Mcginley M.D. Sus reclamaciones y costos en este perodoAprob Medicare todos los servicios? NOServicios denegados 2Vea la pgina 3 para ver las reclamaciones.  Fjese en la columna Fue aprobado el servicio? se indique NO. Para saber qu hacer con las reclamaciones denegadas, vea la ltima pgina.El total que le pueden facturar $150.86Aviso para Andrea TorresNmero de Medicare XXX-XX-1234AFecha de este aviso 16 de septiembre de 2011Reclamacin  procesada entre15 de junio  15 de septiembre de 2011  Exhibit 3.11a  Spanish Part B Deductible: Single MetResumen de Medicarepara la Parte B
3.11_SP_Deductible_PartB_120907.pdf
de septiembre de 2011Reclamacin  procesada entre15 de junio  15 de septiembre de 2011  Exhibit 3.11a  Spanish Part B Deductible: Single MetResumen de Medicarepara la Parte B (Seguro Mdico) El resumen oficial de los Centros de Servicios de Medicare y Medicaid  sobre sus reclamaciones a MedicarePgina 1 de 5Su deducibleEl deducible es la cantidad que usted tiene que pagar por la mayora de los servicios mdicos antes de que Medicare comience a pagar.Deducible de la Parte B:  Usted ha pagado su deducible de $162.00  para el 2010. Ha pagado $85.00  de su deducible de $162.00  para el 2011.Infrmese!Inscrbase en www.MiMedicare.gov para tener acceso directo a las reclamaciones del Medicare Original, hacer un seguimiento de sus servicios preventivos e imprimir el Informe Inmediato para compartirlo con sus proveedores. Visite el sitio Web para registrarse y acceder a su informacin personal de Medicare.ESTA NO ES UNA FACTURAANDREA TORRES  TEMPORARY ADDRESS NAME  STREET ADDRESSCITY, ST 12345-6789Proveedores con reclamaciones durante este perodo18 de junio de 2011  Susan Jones, M.D.28 de junio de 2011  Craig I. Secosan, M.D. 29 de junio  30 de junio de 2011  Edward J. Mcginley M.D. Sus reclamaciones y costos en este perodoAprob Medicare todos los servicios? NOServicios denegados 2Vea la pgina 3 para ver las reclamaciones.  Fjese en la columna Fue aprobado el servicio? se indique NO. Para saber qu hacer con las reclamaciones denegadas, vea la ltima pgina.El total que le pueden facturar $150.86Aviso para Andrea TorresNmero de Medicare
3.11_SP_Deductible_PartB_120907.pdf
NO. Para saber qu hacer con las reclamaciones denegadas, vea la ltima pgina.El total que le pueden facturar $150.86Aviso para Andrea TorresNmero de Medicare XXX-XX-1234AFecha de este aviso 16 de septiembre de 2011Reclamacin  procesada entre15 de junio  15 de septiembre de 2011  Exhibit 3.11b  SpanishPart B Deductible: Met and UnmetResumen de Medicarepara la Parte B (Seguro Mdico) El resumen oficial de los Centros de Servicios de Medicare y Medicaid  sobre sus reclamaciones a MedicarePgina 1 de 5Su deducibleEl deducible es la cantidad que usted tiene que pagar por la mayora de los servicios mdicos antes de que Medicare comience a pagar.Deducible de la Parte B:  Usted ha pagado su deducible de $162.00 para el 2008 y deducible de $162.00  para el 2009. Ha pagado $85.00  de su deducible de $162.00  para el 2011.Infrmese!Inscrbase en www.MiMedicare.gov para tener acceso directo a las reclamaciones del Medicare Original, hacer un seguimiento de sus servicios preventivos e imprimir el Informe Inmediato para compartirlo con sus proveedores. Visite el sitio Web para registrarse y acceder a su informacin personal de Medicare.ESTA NO ES UNA FACTURAANDREA TORRES  TEMPORARY ADDRESS NAME  STREET ADDRESSCITY, ST 12345-6789Proveedores con reclamaciones durante este perodo18 de junio de 2011  Susan Jones, M.D.28 de junio de 2011  Craig I. Secosan, M.D. 29 de junio  30 de junio de 2011  Edward J. Mcginley M.D. Sus reclamaciones y costos en este perodoAprob Medicare todos los servicios? NOServicios denegados 2Vea la pgina 3 para ver las
3.11_SP_Deductible_PartB_120907.pdf
Mcginley M.D. Sus reclamaciones y costos en este perodoAprob Medicare todos los servicios? NOServicios denegados 2Vea la pgina 3 para ver las reclamaciones.  Fjese en la columna Fue aprobado el servicio? se indique NO. Para saber qu hacer con las reclamaciones denegadas, vea la ltima pgina.El total que le pueden facturar $150.86Aviso para Andrea TorresNmero de Medicare XXX-XX-1234AFecha de este aviso 16 de septiembre de 2011Reclamacin  procesada entre15 de junio  15 de septiembre de 2011  Exhibit 3.11c  Spanish Part B Deductible: Multiple Met and Unmet
3.12_SP_Deductible_Benefit_120907.pdf
Sus reclamaciones y costos en este perodoAprob Medicare todas las reclamaciones? SVea la pgina 2 para averiguar cmo leer este aviso.El total que le pueden facturar $2,062.50Resumen de Medicarepara la Parte A (Seguro de Hospital) El resumen oficial de los Centros de Servicios de Medicare y Medicaid  sobre sus reclamaciones a MedicarePgina 1 de 5Su DeductibleEl deducible es la cantidad que usted tiene que pagar por la mayora de los servicios mdicos antes de que Medicare comience a pagar.Deducible de la Parte A:  Usted ha pagado $798.00  de su deducible de $1,068.00  correspondiente a los servicios de hospitalizacin  para el perodo de beneficios que comenz el 27 de mayo de 2011.Infrmese!Inscrbase en www.MiMedicare.gov para tener acceso directo a las reclamaciones del Medicare Original, hacer un seguimiento de sus servicios preventivos e imprimir el Informe Inmediato para compartirlo con sus proveedores. Visite el sitio Web para registrarse y acceder a su informacin personal de Medicare.ESTA NO ES UNA FACTURAANDREA TORRES  TEMPORARY ADDRESS NAME  STREET ADDRESSCITY, ST 12345-6789Centros con reclamaciones durante este perodo18 de junio  29 de junio de 2011  Dr Otero Hospital1 de julio  18 de julio de 2011  Lexington Health CenterAviso para Andrea TorresNmero de Medicare XXX-XX-1234AFecha de este aviso 16 de septiembre de 2011Reclamacin  procesada entre15 de junio  15 de septiembre de 2011  Exhibit 3.12a  Spanish Part A Deductible and Benefit Days: Inpatient  Sus perodos de beneficioLas estadas en el hospital y en un Centro de Enfermera Especializada (SNF en ingls) se miden por das de beneficio