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Primary* INSURANCE 1*| Secondary INSURANCE COMPANY 2
Statement for July 18, 2016
Statement Date
Primary: INSURANCE COMPANY 1 | Secondary: INSURANCE COMPANY 2
Statement Summary $0.00 $8.90 $0.00 $8.90 PREVIOUS BALANCE NEW PATIENT CHARGES PAYMENTS & CREDITS TOTAL AMOUNT DUE - = + $0.00 $0.00 $8.90 >90 Days DELINQUENT 61-90 Days PAST DUE 0-60 Days CURRENT INVOICE DESCRIPTION NEW PATIENT CHARGES SERVICE DATE PAYMENTS / CREDITS Statement Detail 00DM835H $8.90 07/07/16 CPAP SYSTEM - Rental ORDERING MD - ALLSOP, BRUCE N Thank you for using Apria Healthcare. We appreciate your business. PATIENT NAME JANE DOE 0123ABC456 ACCOUNT NUMBER CURRENT INSURANCE INFORMATION Total Amount Due Delinquent $0.00 $8.90 Current Due Past Due $0.00 Due on August 08, 2016 Make a Payment July 18, 2016 CURRENT INSURANCE INFORMATION VIEWING PAGE 1 of 6 View Previous Statement Update Profile Contact Us FAQ Billing Office Information Download PDF $8.90 Tooltip