Rtsinml Medial 



 

 

   

 

 

STATEMENT



FAYIENT
BALANCE

PAYMENTS:

 

 

 

 

 

 

 

 

 

 

 

 

   

 

 

 

 

 

 

   

 

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WIILTAM v: 
1 Be?" at Service. rum/2am
:u'z/IJ/iw gamma/5m

LRuus/m' l?
1 saw 
735m "x MM
73m 
3 9537( mm WI
7%'5 
9928' (Ex
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lug/mm Mum/am:
I "mm
1 - 21%"
was 252.90
93cm mm; mm
'72/15/13 Aow-Ronkn/sml
mwcy 
mes/arm JSEJS
mm
mm
93
sso'ua
1239100 
1353.au
mm>> mm .00
EHIS Ismmo
PAW BALANCE 77 95 . 7 9
MESSAGE: I 
WE SENT A CLAIM To VOUR INSURANCE COMPANY AND SHOW HE ABOVE As YOUR
RESPONSIBILITY. PLEASE CALL Easy 460--8277 TO DEVELOP AN AGREED UPON FAVMENT
PLAN.THANK YOU FOR CHOO ING RUTLAND REGIONAL MEDICAL CENTER.
PAV mun BILL ONLINE, PLEASE VISI 
mm In FAY AMOUNT 7795,79
uAsFfiEH ANETIEIURN vomwm
:[ammd Region-l Medial Center
MAjflIrqu/mulamtkq Mammarm rd ym

160 ALLEN STREET
RUTLAND. VT 06701

SERVICE REQUESTED

   

PHON 586-460-8277
EMAIL: pmiemaocaums(C)rmnocg

can! imam mumm-
Iuvomuon hm china-d. mm mm. china-m on rw-n- mu,



SARAH WITTER

rnthe nteresI coyowpmacy apa' nycled'II/debir
I Thank you

 



STATEMENT NUMBER: --
PAGE: 1 on

may pay onhne a: nr Dy calImg nae-45075271

 

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7795.79 -

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I PAID HERE 55 

nuE DATE

 

 

"27.39 [my

REWTTO: --

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RUTLAND REGIONAL MEDICAL CENTER

PO BOX 1311
WILLISTON. VT 05495-1311

 

 

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PATIENT BALANCE 7795 . 79

 

 

MESSAGE:

WE SENT A CLAIM TO YOUR INSURANCE COMPANV AND SHOW THE BALANCE ABOVE AS YOUR
RESPONSIBILITV. PLEASE CALL (866) 460~8277 TO DEVELOP AN AGREED UPON PAYMENT
FLAN.THANK YOU FOR CHOOSING RUTIAND REGIONAL MEDICAL CENTER.

PAV YOUR BILL DNLINE, PLEASE VISIT: 

a I ms Aunum 7795,79

 

 

 

PLEASE DsrAcM AND RETURN narrow>> PORTION voun "we

 

 

 

 

 

 

 

 

m" "mmfimmfi'ffii 1n the mercy oi your pnvacy, to pay by creumaemt tard you
may pay mum; at by caIIing 5567413078277
160 ALLEN STREET Th you
RUTLAND. VT 05701 I
TEMMEWRN seams: REQUESTED nus me my ms mum a
FOR BILLING INQUIRIES: 779579

      

PHONE: 35545042277 suaw mourn
EMAIL: panemaccoums@m.org mu HERE 
m. box II was" . ham" 0v "mm. STATEMENT fi' 7mm w-
Inlmuon rm chino-d, mums) on uvuu we. PAGE: 2 ol 2 

DUI -- REMITTO: --


SARAH RUTLAND REGIONAL MEDICAL CENTER

PO Box 1311
VT 05495-1311
--

 

 

 

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Ruth nllediul Cull:
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maumuc: FATIE
CHARlxes nmustmims unLnucE BALAL

      

mm mm

7725.7

 

 

 

 

 

aAuncE 7795.79

 

MESSAGES

PLEASE CALL 866? 45078277 TO DEVELOP AN AGREED UPON PAVMENT PLAN. FOR FINANCIAL
ASSISTANCE, ILL NG AND INSURANCE CONTACT THE FINANCIAL COUNSELORS OR CALL
[802) 747-1648. OF OPERATION ARE MOMFRI 3AM T0 5PM

I
I nv VOUR mu. ONLINE, PLEASE VISIT: 
man It PAY nus 179559 7

 

 

 

 

 

 

 

 

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AI 4mm 51mm

    

 

 

STATEMENT

ImsunA

 



   

 

 

 

PATIENT
BALANCE

 

 

 

 

 

 

 

 

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on: a: gem Inna/7:13
"3/30/12 736m MW ml .ou
73610 no 4mm
mum and Adjustment: 
mm mm 715m In 0.00 60,2
BALANCE 

WE SENT A CLAIM To YOUR INSURANCE COMPANV AND SHOW THE BALANCE ABOVE As YOUR
RESPONSIBILITY. PLEASE CALL (366) 45043277 To DEVELOP AN AGREED UPON PAVMENT
PLANITHANK You FDR CHOOSING RUTLAND REGIONAL MEDICAL CENTER.
PAV voun BILL ONLINE, PLEASE VISIT: us-voua-BILLI
man AMOUNTV 56,30

 

 

 

 

 

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STATEMENT

 

 

puma
mum:



 

 

 

 

 

 

 

 

ATE musmws
v15:
Fruv1d
Date cf 5
05/05/19 35415 woman mm
725w bx Hm moo
m2 came moo
mu 9225 mm
451.89
mm mm. 597.05 481.59 a an 115,2
PATENT BALANCE 115 . 20
HEW:
WE SENT A CLAIM To YOUR INSURANCE COMPANV AND SHOW THE BALANCE ABOVE AS YOUR
PLEASE CALL (866 460-8277 TO DEVELOP AN AGREED UPON PAVMENT
PLANVTHANK vou FOR CHOOSIN RUTLAND REGIONAL MEDICAL CENTER.
PAV vcuR BILL PLEASE VISIT: 
warn: 115.20 7

 

 

 

 

 

 

 

Rudmd 'oml Medial Canal I

STATEMENT --

IN mm rump"
nescwnon ADJUSY BALANCE BALANCE

Enzyme: woe/2m
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cum/v 

mm. mm
SUPELYIJMPLANAS

55903 

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mm an

can:

mo mow

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99215 asswmow an
2772; Pan 

emu/w owes/mm

mm x-w

mmy

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upms/umu. coma

scan Human an

raweuts Amusmenr: -252<<3.37

 
 

 

 

    

 

 

mm mm amms 729.243.37 u'uu Nani

 

 

 

 

 

 

 

PATIENT BALANCE 7048.19



WE SENT A CLAIM TO YOUR COMPANY AND SHOW THE BALANCE ABOVE AS YOUR 
PLEASE CALUBBs) 460v3277 TO DEVELOP AN AGREED UPON PAYMENT 
PLANTTHANK YOU FOR CHOOSING RUTLAND REGIONAL MEDICAL CENTER.

 

 

PAY VOUR BILL DNUNE, VISIT: 
ism: -- 7 PAVTNIS mourn 7048.79