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<br />S8 EdJRV1E'w <br />fain'virew HreBR'kh Senikes <br /> <br />I Reflnest For Payment Or Denial <br />..... >l v <br /> <br />I Under Th1edical Pavmentitio Fault Clause. <br />I WeAre Not Billing for Liability. <br />. <br />. <br /> <br />Central Business Office <br />2450 Riverside Avenue <br />Minneapolis, MN 55454-1400 <br /> <br />August 28, 2001 <br /> <br />'TO.. (~'1itJ' oj'(~entervi!le <br />1880 Main Street <br /> <br />POLICY <br />Claim. <br /> <br />C'enterviiie. ivfN 55038 <br /> <br />PATl12iYT' Phyllis Strong <br /> <br />ACCOUNT#- S035592062 <br /> <br />DATE OF SERHCE. 09/28/00 <br /> <br />TYPE OF INJURY: Fall <br /> <br />PL4CE OF iNJURY: Centennial Lakes Path <br /> <br />!)!eu.ye rejer to the Ale{jic'are /f;;/;nini,ytrL.'!Live Bullerirz #.J.76. Due to the./~lct that the above lnentione(j <br />j)[ltient 1-.vas i;-~/1-irea' on -,vour lDFopert): or prOfJert}' -,VOlt insure, we [ire billing ,.,vou ~jor pa.Ylflent or {-tenia! <br />under your medical jXI}'ment/l1ofLw!t insurance coverage. <br /> <br />i\dedicore PCi}'S second 10 o!llypes o(insllrance their paJ''/ur inedien! expensesji.H accIdents thcu OCClIi' on <br />the property of the jnszired~ regardless OfH'ho or what caused the accident. <br /> <br />We mZist hear/rom rhe insurance carrier Hiirh either a payment or denial in order jor lvledicare to <br />consider making paymenT on this aCCOUnT. 1vlEDICARE W7LL ONLY ACCEPT TI-IE DENL4L IF YOU <br />STATE THAT YO[] f-L4y,,'E A NO MEDICAL PAY CLAUSE WITHIN YOUR LL4BILITY INSUR_ANCE <br /> <br />{(possible. please rep()' within three (3) lveeks. Please send correspondence to my attention. <br /> <br />IhCink ..-VOlt, <br /> <br />Vallory lNagner <br /> <br />Va!!ory Wagner, 3rd lC,'j - Mec/Dab <br />lit.7!f}}ie1'1) (-'entrol Businc'ss (Jjj'ice <br />PO Box N7 <br />Mpls AlN 55-1-/0-0147 <br />612-672-2762 <br /> <br />1"L7x 612-672-6454 <br /> <br />RJ~PD1!..J.VL--'l <br />