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XXX Hicks Street, Apt. #XA,
Bronx, NY 10469-1731
646.XXX.XXXX

Jane Doe

November 15, 2005
Manager, Out Patient Service
Montefiore Medical Group
111 East 210th Street
Bronx, NY 10467-2490

Subject: Bill Inquiry

Dear Sir or Madam:

On July 14, Dr. Rainone at the Williambridge, Montefiore Medical Center, saw me. This was just a general visited.

On August 28, I received a bill in the mail for service in the amount of $340.00. My first response was to call in to verify that the clinic had my current medial insurance on file. To my dismay the insurance on file was incorrect. I happily gave the representative by the name of, Marianne Clark, the correct insurance numbers and faxed in a copy of the card to be put on file. I was assured that everything was being taking care of. I was also told to disregard the notice and that a new charge will be sent out the correct insurer.

Since August 28, I am still receiving notices to pay the above amount. I am now being placed......

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Approximate Word Count: 258
Approximate Pages: 2 (250 words per double-spaced page)

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