This document is a medical bill statement from Quest Diagnostics for $227.22 due for a medical test. It provides the patient and guarantor's information, details of the medical services and charges, and states that payment can be made online through MyDocBill. It also notes that the insurance has already been filed to and requests payment to stop any collection efforts.
This document is a medical bill statement from Quest Diagnostics for $227.22 due for a medical test. It provides the patient and guarantor's information, details of the medical services and charges, and states that payment can be made online through MyDocBill. It also notes that the insurance has already been filed to and requests payment to stop any collection efforts.
This document is a medical bill statement from Quest Diagnostics for $227.22 due for a medical test. It provides the patient and guarantor's information, details of the medical services and charges, and states that payment can be made online through MyDocBill. It also notes that the insurance has already been filed to and requests payment to stop any collection efforts.
This document is a medical bill statement from Quest Diagnostics for $227.22 due for a medical test. It provides the patient and guarantor's information, details of the medical services and charges, and states that payment can be made online through MyDocBill. It also notes that the insurance has already been filed to and requests payment to stop any collection efforts.
We have filed to your insurance already. You can pay for the statement amount due in MyDocBill.
Amount Due $227.22 QUEST DIAGNOSTICS PO BOX 740795 CINCINNATI, OH 45274-0795 ACCOUNT OWNER CURTIS SAVAGE mydocbill.com/quest 1-866-254-3883 STATEMENT CREATED 5/31/2022 1-866-254-3859 [email protected] DUE DATE Upon Receipt
Account Summary
INVOICE # PAYMENTS IN THE LAST 30 DAYS PENDING INSURANCE
27297049 $0.00 $0.00 ACCOUNT NUMBER STATEMENT AMOUNT DUE TOTAL AMOUNT BALANCE 17680863-QQUD1 $227.22 $227.22
Guarantor Info
General Info Primary Insurance Info Secondary Insurance Info
CURTIS SAVAGE INSURANCE PROVIDER None 119 RED CLAY RD ATKINS, AR 72823 ADDRESS
, GROUP/PLAN
ID NUMBER
Page 1 of 2 Summary of Service Charges
PATIENT RENDERING PROVIDER REFERRING PROVIDER
CURTIS SAVAGE Quest Diagnostics Provider SHANNAN D SOUZA
Date Proc Code Units Service Activity Charges Pay/ADJ Pending Insur Balance 5/12/2022 83013 1 H PYLORI (C-13) BREATH $227.22 $0.00 $0.00 $227.22 SUBTOTAL $227.22 $0.00 $0.00 $227.22 5/20/2022 Guarantor Responsibility Date TOTAL SERVICES $227.22 $0.00 $0.00 $227.22
Late Payment Breakdown
CURRENT 31-60 DAYS 61-90 DAYS OVER 90 DAYS
$227.22 $0.00 $0.00 $0.00
We have filed to your insurance already. You can pay for the statement amount due in MyDocBill. If your insurance has issued payment directly to you, please send us this payment immediately to stop the collection efforts. Please disregard this notice if you believe you have received it in error or if payment has already been made.
