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HomeMy WebLinkAbout309090 03/07/17 (9) CITY OF CARMEL, INDIANA VENDOR: 371549 ONE CIVIC SQUARE JAMES SKELTON CHECKAMOUNT: S"""""""593.00" CARMEL, INDIANA 46032 12406 OLD MERIDIAN ST APT 206 CHECK NUMBER: 309090 CARMEL IN 46032 CHECK DATE: 03/07/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 5023990 593.00 OTHER EXPENSES cn L � O I L N0 N U c CU O O - O O L C +, O 0 N ca ON m 0 N � U -0 O N O U ECD "O N C +� C (n "O CD +� m N ca LL -rm- a E O +r N n — O O " w U cz (n Z T) cU 0 ami �L O D v P I Z J. O 0 L o Z Za Q w o � a d d a � 3 a ¢ O U 22 a Q ¢ o // 0 e w Z ° o V Q � I v Z z A Z zIL n 75 V4, o W ao CI`T'Y EL JA.NiRS BRAINAM), MPYOR March 1, 2017 James Skelton 12406 Old Meridian St. Apt#206 Carmel, IN 46032 RE: RUN# 20165755:1 DOS 10/09/2016 James Skelton Dear James Skelton: Enclosed you will find a refund check for $593.00. You made three credit card payments and paid this invoice in full 02/22/2017. United HealthCare sent an electronic payment on 02/23/2017 $593.00. Duplicate payments received created overpayment. Refund to be issued to patient James Skelton. If you have any questions, please feel free to contact me at(317) 571-2604. Sincerely, Michelle T. Harrington EMS Billing Administrator CARMEL TIRE DEPARTMENT STYVEN A. COUTs HEAPQL"ARTF.RJ Two CIAIC SOI!ARF. CARMEL. IN 46032 OFFICE 317.571.26Oo. FAX 'ITS71.2615 CARWZ CARMEL FIRE DEPARTMENT Flt%D 2 CIVIC SQUARE CARMEL, IN 46032-2584 (317) 571 2604 Federal ID#356000972 Patient Name: SKELTON,JAMES JAMES SKELTON CARMEL FIRE DEPARTMENT 12406 OLD MERIDIAN ST APT#206 2 CIVIC SQUARE CARMEL, IN 46032 CARMEL, IN 46032-2584 TO ASSURE PROPER CREDIT, RETURN Statement Date Patient ID JAMOUNT PAID THIS PORTION WITH YOUR PAYMENT 03/01/17 990115440 Ticket# : 20165755:1 Date of Service: 10/9/2016 DETACH HERE PATIENT PAID INVOICE IN FULL 02/22/2017. UNITED HEALTHCARE REPROCESSED YOUR CLAIM AND PAID $593.00 ON 02/23/2017. DUPLICATE PAYMENTS REFUND MUST BE SENT TO JAMES SKELTON. THANK YOU MAKE CHECKS PAYABLE TO: CARMEL FIRE DEPARTMENT BALANCE ;$0.00.< Pay online at www.govpaynet.com with PLC#7487 Run Number 20165755:1 Online Payment will charge a service fee. Date'of Service" eDescription` `1'Y Patient Game AChar e s R L pate t h P,a merit s f�,�0Y Charges 10/9/2016 *ADVANCED LIFE SKELTON, JAMES $575.00 10/9/2016 *MILEAGE SKELTON, JAMES $18.00 --------------------------------- Charge Total: $593.00 Payments Paid By: Invoice 10/09/16 $593.00 Paid By: SKELTON, JAMES Payment 01/25/17 ($100.00) Paid By. SKELTON. JAMES Payment 02/17/17 ($100.00) Paid By: SKELTON, JAMES Credit Card Payment 02/22/17 ($393.00) Paid By: UHC NEW BUSINESS COMMERCIAL INSURANCE 02/23/17 ($593.00) Paid By: SKELTON, JAMES REFUND 02/23/17 $593.00 BALANCE $0.00