Medicare Summary Notices - English Exhibits - 2.13_Pay_120907.pdf

MEDICARE PART B CHECK DO NOT DESTROY PLEASE CASH AS SOON AS POSSIBLE HARRIETT I ANSARI BAHMAN 9 JOCKEY LANE NEW CITY, NY 10956-6608 MEDICARE PAYMENT FOR HEALTH INSURANCE – SOCIAL SECURITY ACT Exhibit 2.13 – Pay Check Page MEDICARE PART B CHECK DO NOT DESTROY PLEASE CASH AS SOON AS POSSIBLE HARRIETT I ANSARI BAHMAN 9 JOCKEY LANE NEW CITY, NY 10956-6608 MEDICARE PAYMENT FOR HEALTH INSURANCE – SOCIAL SECURITY ACT Medicare Summary Notice for Part B (Medical Insurance) The Official Summary of Your Medicare Claims from the Centers for Medicare & Medicaid Services Exhibit 2.13 – Pay Check Page with Title Bar Medicare Summary Notice for Part B (Medical Insurance) The Official Summary of Your Medicare Claims from the Centers for Medicare & Medicaid Services Your Deductible Status Your 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 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. HARRIETT I ANSARI BAHMAN 9 JOCKEY LANE NEW CITY, NY 10956-6608 ¿Sabía que puede recibir este aviso y otro tipo de ayuda de Medicare en español? Llame y hable con un agente en español. 如果需要国语帮助，请致电联邦医疗保险，请先说“agent”, 然后说”Mandarin”. 1-800-MEDICARE (1-800-633-4227) Your Claims & Costs This Period Did Medicare Approve All Services? YES See page 2 for how to double-check this notice. Total You May Be Billed $0.00 Providers with Claims This Period June 18, 2011 Bruce M Rodin Page 1 of 4 CHECK ENCLOSED This Is Not A Bill Notice for Jennifer Washington Medicare Number XXX-XX-1234A Date of This Notice July 15, 2011 Claims Processed July 15, 2011 Exhibit 2.13 – Pay MSN page 1