| - « o s # A P t n d | |
| ft. COMPANY,. V I ^ I h I % l ■ ■ U | |
| Postr Office Box 589 | |
| LaGrange, Kentucky 40031-0589 | |
| Phone: 1-888-258-8060 ext. 4581 | |
| Fax: 502-753-7380 | |
| Patricia Murray | |
| July 26,2024 | |
| COB REFUND REQUEST | |
| Third Request | |
| St. Francis Hospital/The Heart Center | |
| Billing/Refund Dept | |
| PO Box 95000-6560 | |
| Philadelphia, PA 19195 | |
| RE: Patient: KAMENEY RAMSAMOOJ Date of Service: 01/29/2024 - 01/29/2024 | |
| Patient ID#: 49200807800 Refund Amount: $150.50 | |
| Patient DOB: 07/25/1965 | |
| ATTN: REFUND/BILLING: | |
| Our Client, Aetna, has paid benefits for services identified above as the Primary Insurer in error. Oxford | |
| Health Plan, located at PO Box 29130, HOT SPRINGS, AR 71903, should have paid for these services | |
| as primary. *See Claims Detail on reverse | |
| We have previously sent a letter regarding this matter but have not received a refund. It is very | |
| important that we are contacted as soon as possible to ensure that the correct primary insurance has been | |
| invoiced. Upon receipt of the notice, please contact Jennifer Waford at (502) 716-6979 to discuss this | |
| matter. Please respond or submit a refund within 30 days to resolve this matter and avoid further | |
| collection efforts. | |
| Otherwise, please send this letter and a copy of the EOB or EOMB from the primary coverage with your | |
| payment so that the overpayment amount can be correctly calculated. Please forward to: | |
| The Rawlings Company LLC | |
| P.O. Box 589 | |
| LaGrange, KY 40031-0589 | |
| Sincerely, | |
| Jennifer Waford | |
| FILE #3824-4018173, pm2 | |
| AETNA_LDL3_COMM | |
| Aetna is the brand name used for products and services provided by one or more of the Aetna group companies. (Aetna) | |
| Aetna performs administrative services, including overpayment recovery and collection, for other health carriers including but not limited to: | |
| Innovation Health, Texas Health Aetna, Banner Aetna, Sutter Health Aetna, and Aliina Aetna. | |
| I Claim # I* Service Date Patient Account Billed Amount Paid Amount OPID | |
| I EQJNCX52M00 I 01/29/2024 I 13240090299404 | $772.00 I $150.50 | • 80451456 ~~| |