Ursa Major

August 16, 2016After review of the complaint and applicable account it has been determined that per the insurance that *** *** selected, which is *** *** *** of ***, indicates that we were to charge $2,instead of $1,for this procedure and we have to charge the
contracted amount - Evangelical Community Hospital treats all patients the same and bills according to the health insurance program that the patient selectedPlease see breakdown below that we received from *** ***s' selected insurancecompany: PROC# Charge $ Allowed $ *** Adjustment Pt Deductible Pt CO-Insurance *** $1, $2, -$ $ $285.18Total Outstanding Balance $ $285.18Total Patient Responsibility $573.24Please see attached Electronic Remittance Advise from *** *** *** of *** for your reference regarding the accuracy of our statement.Should you have any questions, please do not hesitate to contact Evangelical Community Hospital at (570) 768-3000.Sincerely,Sharon H. Director, Patient Financial Services