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Home My WebLink About981385.tiff • BOARD OF COUNTY COMMISSIONERS PHONE (970) 356-4000, EXT.4200 VIED FAX: (970) 352-0242 P.O. BOX 758 GREELEY, COLORADO 80632 • COLORADO July 14, 1998 MR. HARRISON HULL 33681 WELD COUNTY ROAD 13 WINDSOR CO 80550-3000 RE: Ambulance Service Bill Dear Mr. Hull: Thank you for your inquiry regarding the ambulance services provided for your wife, Bettie, on May 15, 1998. The ambulance department is a non-profit, fee-for-service agency of Weld County Government.mulace charges are costs to pNo tax dolars rovide selrvices.r Con equen ly,we do noe utilized. ed Countytacceptnassignment of nsura n e benefits on the taslpayment in full. A review of the services and billing has been made. No overcharges were found, and the original statement appears to be in order. You should be receiving a second check from your private insurance carrier very soon. Many if not most, Medicare patients carry supplemental insurance plans. They do so because Medicare reimbursements are often based on information that does not appropriately reflect the true costs of providing medical care. If you have questions or need additional information, please feel free to call the Ambulance Department at (970) 353-5700. Thank you. Sincerely, BOARD �O,OF COUNTY COMMISSIONERS ! Constance L. Harbert, Chair Q nda 981385 /9 100001782 202118518 THIS IS NOT A BILL Explanation ©f Your Medicare Part B B enefits 1/741/4y crt / / [7 Summary of this notice dated June 9, 1998 ' Total charges: $ 615.00 BETTIE L HULL Total Medicare approved: $ 286.38 :OM 33681 WCR 13 WINDSOR CO 80550 We are paying you: $ 229. 10 Your total responsibility: $ 615.00 Your Medicare number is: 522-24-7216A Your provider did not accept assignment. Mar NUM Details about this notice Seethe back for more.information.) IM Claim control number 02-98148-257-110 iiI9M BILL SUBMITTED BY: Weld Cnty Amb (C64603) Mailing address: 1121 M St, Greeley, CO 80631-9587 See Medicare Notes Dales Services and Service Codes Chain Amoroved Below May 15, 1998 1 Basic emer sep mile & supply (A0362-RH) $ 420.00 $ 178.04 a May 15, 1998 9Basic life support mileage (A0380-RH) 90.00 31 .41 a May 15, 1998 1 Ambulance 02 life sustaining (A0422-RH) 45.00 26.93 a May 15, 1998 1 Als IV drug therapy supplies (A0394-RH) + 60.00 + 50.00 a Total $ 615.00 $ 286.38 b Your provider(s) did not accept assignment. We are paying you the amount that we owe you. See #4 on the back. Notes: a The approved amount is based on the customary charge. b This information is being sent to your private insurer. They will review it to see if additional benefits can be paid. Send any questions regarding your supplemental benefits to them. GENERAL INFORMATION ABOUT MEDICARE: New Year, More Medicare Benefits! Medicare has added benefits to help you stay healthy. These benefits now include: flu and pneumococcal pneumonia shots (Medicare pays 100%); pap smears, including pelvic and breast exam and yearly mammograms (no Part B deductible); and colorectal cancer screening. Talk to your doctor to see if these benefits are right for you. Even more Medicare benefits will be available beginning July 1 , 1998. Look for more information. IMPORTANT: If you have questions about this notice, call Medicate Fart B at 303/831.2601 or 1-800/332.6681 or see us at Medicare Part B, 730 N Simms St, Suite 100, Golden, CO 80401. You eau write us at Medicare Operations, PO SO 6028, Fargo,ND 58108-6028. You will need this notice if you contact us. To appeal our decision, you must WRITE to us before December 9, 1998. See #2 on the back. ~'" Hello