HomeMy WebLinkAbout309119 03/07/17 CITY OF CARMEL, INDIANA VENDOR: 371550
ONE CIVIC SQUARE UNITEDHEALTH GRP RECOVERY SERVICKCK AMOUNT: $......*621.60*
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CARMEL, INDIANA 46032 PO BOX 740804 CHECK NUMBER: 309119
ATLANTA GA 30374-0804 CHECK DATE: 03/07/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 5023990 621.60 OTHER EXPENSES
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JAMEs BRAINARD, MAYOR
February 23, 2017
UNITEDHEALTH GROUP RECOVERY SERVICES
P.O. BOX 740804
ATLANTA, GA 30374-0804
RE : Marianne Truax 20165805 :1 DOS 10/12/2016
Dear Sir/Madam:
Enclosed you will find a check in the amount of$621.60.
This claim was paid by United Health Care on 11/17/2016.
Liberty Mutual Worker's Compensation Insurance paid this claim in full $777.00
on 01/25/2017.
Duplicate payment received-created an overpayment of$621.60.
Refund Health Insurance United HealthCare $621.60
If you have any questions, please feel free to contact me at (317) 571-2604.
Sincerely,
Michelle T. Harrington
Billing Administrator
CAP-MEL FIRE DEPARTMENT
STE-VEN A. COUTs HEADQUARTERS
Two CIVIC S( -ARE, CARMEL, IN 46032 OFFICE 317.571.26Qo, FAx 317.571.2615
GiLumt CARMEL FIRE DEPARTMENT
F ,D 2 CIVIC SQUARE
CARMEL, IN 46032-2584
Qz`Tw• (317) 571 2604 Federal ID#356000972
Patient Name: TRUAX, MARIANNE
MARIANNE TRUAX CARMEL FIRE DEPARTMENT
8118 CROOK DR N 2 CIVIC SQUARE
INDIANAPOLIS , IN 46256 CARMEL, IN 46032-2584
TO ASSURE PROPER CREDIT, RETURN Statement Date Patient IDAMOUNT PAID
THIS PORTION WITH YOUR PAYMENT 02/23/17 990115468
Ticket#: 20165805:1
Date of Service: 10/12/2016
DETACH HERE
CLAIM PAID BY UNITED HEALTH CARE $621.60. LIBERTY MUTUAL WORKER'S
COMPENSATION INSURANCE PAID IN FULL$777.00. SENDING OVERPAYMENT TO UNITED
HEALTH CARE INSURANCE
MAKE CHECKS PAYABLE TO: CARMEL FIRE DEPARTMENT
BALANCE
Pay online at www.govpaynet.com with PLC#7487 Run Number 20165805:1
Online Payment will charge a service fee.
Datkdf Service Description Patient Name ' Charge(s) Date P�ayment(s)
a ,SFS."'?
Charges
10/12/2016 *BASIC LIFE SUP TRUAX, MARIANNE $675.00
10/12/2016 *MILEAGE TRUAX, MARIANNE $102.00
---------------------------------
Charge Total: $777.00
Payments
Paid By: Invoice 10/12/16 $777.00
Paid By: UHC NEW BUSINESS COMMERCIAL INSURANCE 11/17/16 ($621.60)
Paid By: LIBERTY MUTUAL/7203 COMMERCIAL INSURANCE 01/25/17 ($777.00)
Paid By: UHC NEW BUSINESS REFUND 02/23/17 $621.60
BALANCE $0.00