Sta9211912184 10622176 10625928.zip
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Pratyush KesarwaniSta9211912184 10622176 10625928.zip
Uploaded by
Pratyush KesarwaniAPD{3120877894} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8118275482
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354882 Upon Receipt $0.00 $
Page 1 of 1
FDFFFFFDATATDTTADADDDTTFATFADAATAATTFAFTDTADFAFDDTTATDAFTFTDTTDTD ATAFADDTTTTDTTFADDATTTTFDDAAFFFFTTAATAFAADDFFAFDFATAAFFFFFTTTAAFD
EMORY GARY STEWART MORGAN MEDICAL CENTER
1170 SULGRAVE DR PO BOX 860
MADISON GA 30650-4614 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354882 EMORY GARY STEWART 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/02/24) EMORY G STEWART
Provider: Long, Leah LPN
08/02/2024 STERILE SUPPLY $40.28
08/02/2024 CLINIC $698.00
08/02/2024 DRUGS/DETAIL CODE $600.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,338.28
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120877909} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7944455034
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354880 Upon Receipt $0.00 $
Page 1 of 1
DATTFAAATDFFTDDDATFAFDTAAFDDDTDFTDDDDFFTTAFAAADFDDAADDFFAFTFTDDDA ADFTTFFADDFDFAAATATADAFFTAADFADDFTTFAFTFFADDFATDATDTDTFTAAAATTTTT
TRAMPUS L SHELNUTT MORGAN MEDICAL CENTER
1000 HODGES AVE PO BOX 860
MADISON GA 30650-2042 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354880 TRAMPUS L SHELNUTT 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/29/24) TRAMPUS L SHELNUTT
Provider: DIAMANDOPOULOS, LAURA A MD
07/29/2024 LAB/CHEMISTRY $87.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ..........................................$87.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120877916} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629598
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354879 Upon Receipt $0.00 $
Page 1 of 1
TAATATFDATAAFFTFTTFAATTDFTAFFDTADDFTATFFTTFFATAFADTTTTDTAFAFDFDFD TFTDDTADFDAAAATDATAFFFAAFATATTADDFDTFATDDAAAADDFTTADDTADTDFADDFAA
KAYLA VAARTJES MORGAN MEDICAL CENTER
1021 WINDSOR CREEK DR PO BOX 860
MADISON GA 30650-4516 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354879 KAYLA VAARTJES 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/31/24) KAYLA VAARTJES
Provider: Iwelunmor, Anthony MD
07/31/2024 PHARMACY $60.00
07/31/2024 NON-STER SUPPLY $31.48
07/31/2024 STERILE SUPPLY $7.76
07/31/2024 LABORATORY $268.50
07/31/2024 LAB/CHEMISTRY $568.00
07/31/2024 LAB/HEMATOLOGY $256.00
07/31/2024 DX X-RAY/CHEST $171.00
07/31/2024 EMERG ROOM $1,943.00
07/31/2024 EKG/ECG $154.00
07/31/2024 Patient payment -$250.00
Patient Balance -$250.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$3,459.74
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: .............-$250.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120877934} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7999816264
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354878 Upon Receipt $0.00 $
Page 1 of 1
DATAFAFTADFATATFTAFAFDAAAADDADAFFFTDFAAATTAFTATFADFADDAAATTADFFDD FFAFDTFTAFATTDADDTFAAFADDTDAFTATTDTTTTTAFFAFTTDFFDTAATTFAADFADAFA
DESTINY M WYATT MORGAN MEDICAL CENTER
1201 HAYES ST PO BOX 860
MADISON GA 30650-3607 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354878 DESTINY M WYATT 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/02/24) KAYDEN K WYATT
Provider: Rafeedie, George Kaleel MD
08/02/2024 PHARMACY $12.00
08/02/2024 EMERG ROOM $1,628.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,640.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120877946} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629163
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354875 Upon Receipt $0.00 $
Page 1 of 1
AFAAADFTFADTDTAAFTFDDDTAADDTDAAAFATTTFTFDAFDFFFTTFTDDFTDFFADTTDDD DDDATFAFTFFFDDTAFADFTAFTATFDTADTAADFDDTTDFDTDFTTDDFFTTDATTTFFTFDT
BRENDA H STOCKDALE MORGAN MEDICAL CENTER
430 PITTS CHAPEL RD PO BOX 860
NEWBORN GA 30056-1903 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354875 BRENDA H STOCKDALE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/26/24) BRENDA H STOCKDALE
Provider: Werkin, Jacob MD
07/26/2024 CLINIC $130.00
07/26/2024 PRO FEE/CLINIC $260.08
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$390.08
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120877957} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8015158472
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354874 Upon Receipt $0.00 $
Page 1 of 1
ADDAFDAAFDDDTTAAFFFFDDFATAFDTAFFTAAADFTTTFDTFTDDTDTTDADATDTFTDFDF DTTDADTDDATFAFDAADFDDTTTFFFATFFADAFAFDFDTTDADFFTTFADFFDDDDADFAFAD
SOMMER M BLACKWELL MORGAN MEDICAL CENTER
3526 HIGHWAY 11 S PO BOX 860
MANSFIELD GA 30055-3230 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354874 SOMMER M BLACKWELL 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/01/24) SOMMER M BLACKWELL
Provider: Iwelunmor, Anthony MD
08/01/2024 PHARMACY $24.00
08/01/2024 LABORATORY $133.00
08/01/2024 LAB/IMMUNOLOGY $85.00
08/01/2024 LAB/BACT-MICRO $86.00
08/01/2024 EMERG ROOM $1,628.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,956.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120877977} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7865412706
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354873 Upon Receipt $0.00 $
Page 1 of 1
FTFTADFAFTAATTDTFATFDDATFFFFFFTFDTTDFDAAAATFFATDADTFFDFFAATDFTFDD FAFTFADAFADTFFFDTFDTFDDDTFDDFDTAFDADATFFATADTTAAAFDTFFTTFAFDAFTTF
RONALD E REAMS MORGAN MEDICAL CENTER
1101 CONFEDERATE RD PO BOX 860
MADISON GA 30650-2257 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354873 RONALD E REAMS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/01/24 - 08/02/24) RONALD E REAMS
Provider: Wingate III, Harry Lynnwood MD
08/01/2024 LABORATORY $146.00
08/01/2024 LAB/CHEMISTRY $294.00
08/01/2024 LAB/HEMATOLOGY $64.00
08/01/2024 LAB/UROLOGY $6.00
08/01/2024 CT SCAN/BODY $1,288.00
08/01/2024 EMERG ROOM $2,799.00
08/01/2024 DRUGS/DETAIL CODE $104.02
08/02/2024 PHARMACY $79.28
08/02/2024 NON-STER SUPPLY $31.48
08/02/2024 STERILE SUPPLY $26.92
08/02/2024 EMERG ROOM $296.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$5,134.70
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120877988} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8188248724
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354871 Upon Receipt $0.00 $
Page 1 of 1
DTDTTDAFDFFFFFTTDTDDDDAATDADAFFAATAATFDDDTTDDDADTTFDFTTDTDTFFTDTD FTDFFDTAAATAFDFTFFFTTDDTDDDTDFAAATFTTTFDADAADTFTDFTDTFTDDFDDAADFF
DONALD M BOSWELL MORGAN MEDICAL CENTER
2001 SWORDS TRL PO BOX 860
BUCKHEAD GA 30625-2052 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354871 DONALD M BOSWELL 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/01/24) DONALD M BOSWELL
Provider: Iwelunmor, Anthony MD
08/01/2024 PHARMACY $24.00
08/01/2024 DRUGS/INCIDENT RAD $500.00
08/01/2024 IV SOLUTIONS $114.18
08/01/2024 STERILE SUPPLY $19.16
08/01/2024 LABORATORY $622.25
08/01/2024 LAB/CHEMISTRY $393.00
08/01/2024 LAB/IMMUNOLOGY $102.00
08/01/2024 LAB/HEMATOLOGY $64.00
08/01/2024 LAB/UROLOGY $6.00
08/01/2024 CT SCAN/BODY $2,778.00
08/01/2024 EMERG ROOM $3,584.00
08/01/2024 DRUGS/DETAIL CODE $496.88
08/01/2024 EKG/ECG $154.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$8,857.47
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120877996} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8191162274
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354869 Upon Receipt $0.00 $
Page 1 of 1
FDDFTAAAFFADFDFDFDTAATAAAADDTDFFAFTDFTDATDAATDTFFTAFTTAFADDAFDAFF DAAAAADDTADDADDFDDDDATTDADFFADDATFAFDDFFTDDDTFAFFFFTAFDTFDTDFFTDD
JOSIE L MORRIS MORGAN MEDICAL CENTER
186 GA HIGHWAY 81 PO BOX 860
OXFORD GA 30054-3203 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354869 JOSIE L MORRIS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/01/24) KARLEIGH MORRIS
Provider: Wingate III, Harry Lynnwood MD
08/01/2024 LABORATORY $133.00
08/01/2024 LAB/BACT-MICRO $86.00
08/01/2024 EMERG ROOM $1,628.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,847.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878009} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7874513729
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354868 Upon Receipt $0.00 $
Page 1 of 1
FAFFDTDTFADTADTDFTATFAAFTFDFTTDATFAFAAADTTFFTFFFAFADTATTDTFFDFFFF DFFDTTFFDFADDFTFTAFFFAFDFAFTATFTFFTAFTTADADFTFDFADAAFTDFATAFFDTAT
CATHY E SHIELDS MORGAN MEDICAL CENTER
1331 TRIMBLE BRIDGE RD PO BOX 860
MADISON GA 30650-3317 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354868 CATHY E SHIELDS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/31/24) CATHY E SHIELDS
Provider: Cannington, Sara Danielle FNP
07/31/2024 PRO FEE/OUTPT $306.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878019} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7924324461
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354866 Upon Receipt $0.00 $
Page 1 of 1
TFDFATFDATATFFAFAAFTFATFATATDTFDFFDFTDTDFFTDTTTFDTFDFTTTADTTFDDDT FDTTDFATFFFATFATATDADFATTADFDATTDTDDADTTFAATDTTTTDDFFTTATAFFATFTA
BERTHA ANITA ANDREWS MORGAN MEDICAL CENTER
755 PEARL ST APT A PO BOX 860
MADISON GA 30650-1027 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354866 BERTHA ANITA ANDREWS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/31/24) BERTHA A ANDREWS
Provider: Iwelunmor, Anthony MD
07/31/2024 PHARMACY $12.00
07/31/2024 DX X-RAY $184.00
07/31/2024 CT SCAN/BODY $2,729.00
07/31/2024 EMERG ROOM $1,943.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$4,868.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878032} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629597
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354864 Upon Receipt $0.00 $
Page 1 of 1
FTAAAFAFDAFDDDTTTTDATDTFTDTDAFAATTFDFTFTAFFAFFFTATAAADAATFADDTTAA TDAADFFDADFTATTTDTTFTFAFATTFAATDTATDDFTFDFADFDTTFTFTATATADDADTTDA
THANH LIEM NGUYEN MORGAN MEDICAL CENTER
562 VINE ST PO BOX 860
MADISON GA 30650-1714 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354864 THANH LIEM NGUYEN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/29/24) THANH L NGUYEN
Provider: NGUYEN, LONG BAO DO
07/29/2024 LABORATORY $146.00
07/29/2024 LAB/CHEMISTRY $373.00
07/29/2024 LAB/HEMATOLOGY $64.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$583.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878046} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629595
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354862 Upon Receipt $0.00 $
Page 1 of 1
TFAAFTDFFAAFDADFADFFAAATFAATFDTTDDADFFTAADDFTFAFTFFATTAAATATTDATF AFDFTTAATDAFFTAFFAAAAAFADTATDTFDADDATATDFFDAAADADTTDATFDTFTATDDFT
MOLLY BOROUGH MORGAN MEDICAL CENTER
1310 BAYSIDE DR PO BOX 860
GREENSBORO GA 30642-6168 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354862 MOLLY BOROUGH 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/01/24) MOLLY BOROUGH
Provider: Cannington, Sara Danielle FNP
07/01/2024 LABORATORY $43.00
07/01/2024 LAB/HEMATOLOGY $64.00
07/01/2024 PRO FEE/OUTPT $306.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$413.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878057} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629297
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354861 Upon Receipt $0.00 $
Page 1 of 1
FTTADTTDAAADAATDTTFTFTAFFFAATTFDDFDFFDDTFFDAAATFFAFFATFFADDAFFTAF AATTAATTDTDFTAFFADTTFTTATFAFDDDFDDFFAFFTATFTAAAFTADFDFFADFATTFDTD
SHEENA CLEVELAND MORGAN MEDICAL CENTER
609 HARRIS CT PO BOX 860
CONYERS GA 30012-6513 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354861 SHEENA CLEVELAND 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/28/24) SHEENA CLEVELAND
Provider: Brown, Kirk Tahama MD
07/28/2024 PHARMACY $12.00
07/28/2024 DX X-RAY $159.00
07/28/2024 EMERG ROOM $1,628.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,799.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878073} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8192469023
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354859 Upon Receipt $0.00 $
Page 1 of 1
FTTDAFDFAATDDDTAFDFDTAFDAFFTAFFFDTDFFADAADTAFDDTFFTFAFDADAFDAAAFT TTFDFDDFFTTTDADTTFADDDDFFFTTAFAFFAATFAFATTTFFDFTAAAADFAFFDFTDAAAF
JEROME PATRICK MORGAN MEDICAL CENTER
2451 PIERCE DAIRY RD PO BOX 860
MADISON GA 30650-4940 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354859 JEROME PATRICK 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/02/24) JEROME PATRICK
Provider: Wingate III, Harry Lynnwood MD
07/02/2024 DRUGS/INCIDENT RAD $500.00
07/02/2024 NON-STER SUPPLY $31.48
07/02/2024 STERILE SUPPLY $611.07
07/02/2024 LABORATORY $268.50
07/02/2024 LAB/HEMATOLOGY $64.00
07/02/2024 LAB/UROLOGY $6.00
07/02/2024 CT SCAN/HEAD $1,545.00
07/02/2024 CT SCAN/BODY $4,002.00
07/02/2024 EMERG ROOM $1,943.00
07/02/2024 DRUGS/DETAIL CODE $14.00
07/02/2024 EKG/ECG $154.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$9,139.05
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878090} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7975524390
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354858 Upon Receipt $0.00 $
Page 1 of 1
ADDTTDDAFFTTDTFAAFTTDAAFFAFDFFATDTFTADDADFTDFADDAATATFTFDDFDDAADT DTFTTFDFDFDDDFTATFDFDTFDAFFDAADADATFFDAATAFDDFTDAFFADADAFTAFFATTT
THOMAS JAMES BRINEY MORGAN MEDICAL CENTER
553 E JEFFERSON ST LOT 3 PO BOX 860
MADISON GA 30650-1752 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354858 THOMAS JAMES BRINEY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/25/24) THOMAS J BRINEY
Provider: Pepper, Robert Thomas MD
07/25/2024 CLINIC $130.00
07/25/2024 PRO FEE/CLINIC $176.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878105} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8152562568
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354854 Upon Receipt $0.00 $
Page 1 of 1
DAADAADDTFTAATFFDFFAAFTTTFFAATDADFFAFATFAAFFTFAFFAFTDATTDDAADFTDA FATDDTTTFFTATFADADFAFDATDFDADTAAFDDTATATAATATTDFTFTFDATFDFFFAFFAA
ROY L SAINT MORGAN MEDICAL CENTER
1600 BETHANY RD UNIT 3001 PO BOX 860
MADISON GA 30650-4845 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354854 ROY L SAINT 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/03/24) ROY L SAINT
Provider: Pepper, Robert Thomas MD
07/03/2024 CLINIC $130.00
07/03/2024 PRO FEE/CLINIC $176.15
07/25/2024 Medicare payment -$40.77
07/25/2024 Contractual Allowance Adjustment -$239.38
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ........-$280.15
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878122} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8120485046
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354853 Upon Receipt $0.00 $
Page 1 of 1
DFFDATDFADTTTFADDFDTAFDDFTATFDDDAFFDTADTDDATTTAFAFDFDFFAFDTAAFTFT FFDAFAAAAAFAFDFDFADTAFDTTTDDDDTTTDFDTDDDFDATTTAADDDDTDTTTFDDADDDF
CHARLIETTE L HARRIS MORGAN MEDICAL CENTER
1060 MICHA CIR APT A PO BOX 860
MADISON GA 30650-2095 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354853 CHARLIETTE L HARRIS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/25/24) CHARLIETTE L HARRIS
Provider: Cannington, Sara Danielle FNP
06/25/2024 LABORATORY $241.00
06/25/2024 LAB/CHEMISTRY $25.00
06/25/2024 LAB/HEMATOLOGY $64.00
06/25/2024 PRO FEE/OUTPT $390.08
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$720.08
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878136} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629592
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354850 Upon Receipt $0.00 $
Page 1 of 1
TTFATAFADDATFDDFTTFATDDDATDDDFATTFTFAAAADDADTADFAAAFAADFDFTDTFDFD DDAFADFDTAADADDADTFDTATDFTFAAFFTAAAADTDFDDDFDFFDFDATADDDADTDFTTFD
MOLLY R MCGOFF MORGAN MEDICAL CENTER
4207 SILVERMERE WAY PO BOX 860
CHARLOTTE NC 28269-1346 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354850 MOLLY R MCGOFF 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/21/24) MOLLY R MCGOFF
Provider: Spencer, Dennis DO
07/21/2024 PHARMACY $136.00
07/21/2024 NON-STER SUPPLY $31.48
07/21/2024 STERILE SUPPLY $26.92
07/21/2024 LABORATORY $268.50
07/21/2024 LAB/CHEMISTRY $505.00
07/21/2024 LAB/HEMATOLOGY $256.00
07/21/2024 DX X-RAY/CHEST $171.00
07/21/2024 EMERG ROOM $1,943.00
07/21/2024 EKG/ECG $154.00
07/21/2024 Patient payment -$300.00
Patient Balance -$300.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$3,491.90
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: .............-$300.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878148} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629590
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354846 Upon Receipt $0.00 $
Page 1 of 1
TTTAADFDFTADTDAAAFFDDAAFFTFTDFADTAATFDDTDTFADATDAATAFAFATADDAADAT ADTDADATDTAFTAFAATATDATADAAADFFDFTFAAADTFTFAFAFTTTTFDDFFTFATTTFAD
IRENE ROBBINS MORGAN MEDICAL CENTER
1061 WILLOW RUN RD PO BOX 860
GREENSBORO GA 30642-2760 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354846 IRENE ROBBINS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/02/24) IRENE ROBBINS
Provider: Cossio, Miguel Eduardo MD
08/02/2024 CT SCAN/HEAD $1,545.00
08/02/2024 Patient payment -$300.00
Patient Balance -$300.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,545.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: .............-$300.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878161} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7980938714
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354845 Upon Receipt $0.00 $
Page 1 of 1
FADFDAFFDDADDFTDTFAAADATDFFTDDFDADTADFATFADFTFDAAFTFDTAFTFTTFFFTT TFFTFAFFFTFTDADDTATDFFDFAATDADTDDFADFFDADTTDADAFATFADDAAADFTDDTTF
MICHAEL J HUTCHINS MORGAN MEDICAL CENTER
1921 WEAVER JONES RD PO BOX 860
RUTLEDGE GA 30663-2951 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354845 MICHAEL J HUTCHINS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/25/24) MICHAEL J HUTCHINS
Provider: Werkin, Jacob MD
06/25/2024 PRO FEE/CLINIC $351.52
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$351.52
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878172} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7988770320
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354844 Upon Receipt $0.00 $
Page 1 of 1
FFAFFATAFFAATAFDFDATFATAADFTTDFFAFFAAFDTTTDATTDAFAFAFDFFDDTDTDTTF TAAFDTDDADTTATTDDDAFADAFFDTAATAFAFTTDAAFTFAFADDAFAATAAADFDDADFTFA
ELIZABETH A MOORE MORGAN MEDICAL CENTER
3141 DOSTER RD PO BOX 860
RUTLEDGE GA 30663-2215 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354844 ELIZABETH A MOORE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/01/24 - 07/31/24) ELIZABETH A MOORE
Provider: POLING, JON
07/08/2024 PHYSICAL THERAPY $219.00
07/10/2024 PHYSICAL THERAPY $219.00
07/15/2024 PHYSICAL THERAPY $219.00
07/18/2024 PHYSICAL THERAPY $219.00
07/23/2024 PHYSICAL THERAPY $219.00
07/10/2024 Patient payment -$20.00
07/18/2024 Patient payment -$20.00
07/23/2024 Patient payment -$10.00
Patient Balance -$50.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,095.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$50.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878184} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629589
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354841 Upon Receipt $0.00 $
Page 1 of 1
FFFTTAFTAAFTFATDTTDFFDTAFAATDTDTDDTAAAFDDTTTATAFTDATTDTDTDTAADAAT ATDATFTATDDFFTAAFFTATTFATDADDADFTTDFTFADAFDTFATTDADDAAFTDFTATADDT
RAVEN THORNTON MORGAN MEDICAL CENTER
4130 SEVEN ISLANDS RD PO BOX 860
MADISON GA 30650-5642 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354841 RAVEN THORNTON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/05/24) RAVEN THORNTON
Provider: Fletcher, David Troy MD
08/05/2024 ULTRASOUND $1,004.00
08/05/2024 Patient payment -$15.33
Patient Balance -$15.33
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,004.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$15.33
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878197} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7915417054
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354840 Upon Receipt $0.00 $
Page 1 of 1
FFTAFATAADTTDTADFFFAAAADDAATDTFDAFFTFDDTFDATATFFTADAAFDFFATTFFDAT FATFTTTTTFTFADAFFDFAATATDDFADTFAADDATTADAFFATADFDFTDTADDDFTFAFDFT
BERNICE JOHNSON BAKER MORGAN MEDICAL CENTER
1121 HARPER CT PO BOX 860
MADISON GA 30650-1471 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354840 BERNICE JOHNSON BAKER 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/30/24) BERNICE J BAKER
Provider: McAlpine, Steven B MD
07/30/2024 LABORATORY $133.00
07/30/2024 LAB/IMMUNOLOGY $85.00
07/30/2024 EMERG ROOM $1,628.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,846.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878208} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629586
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354837 Upon Receipt $0.00 $
Page 1 of 1
DTTADDADTAFDTTFTDFFTTDADDDDTDFADTTTDAAFTDFAADDTDFAFFFTFAATFDTAFFT DTFADFDFAFDTFDTTDFDFTDFDADDDAATATATDDDAFTFTDDDTTFFFTTATTFDDFFAADA
TEAGAN LANGENESS MORGAN MEDICAL CENTER
1391 KEENCHEEFOONEE RD PO BOX 860
RUTLEDGE GA 30663-2818 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354837 TEAGAN LANGENESS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/31/24) TEAGAN LANGENESS
Provider: Cannington, Sara Danielle FNP
07/31/2024 PRO FEE/CLINIC $351.52
07/31/2024 Patient payment -$35.00
Patient Balance -$35.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$351.52
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$35.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878217} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7876713968
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354836 Upon Receipt $0.00 $
Page 1 of 1
AFFTTTFAADAAAAAAAATFTDFFADFAFFDDFFDAATDTDTTDFATFTFAFFATDATDTDFDFT DDADFDFDFAATTFDTTTFDDFTDFADAAFATFAATFDDADTTFDDFTADAADDTFADFDFTAAF
CYNTHIA OXENDINE SLUDER MORGAN MEDICAL CENTER
820 FOREST HILL RD PO BOX 860
PERRY GA 31069-3623 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354836 CYNTHIA OXENDINE SLUDER 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/24/24) CYNTHIA O SLUDER
Provider: RABER, PAUL EDWARD
07/24/2024 DX X-RAY $504.00
07/24/2024 SCRN MAMMOGRAPHY $298.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$802.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878229} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8196889559
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354835 Upon Receipt $0.00 $
Page 1 of 1
AADTFAFDFTADADTDFDTAAATTADDTFTTTFDFDDATFFTATTATAFFTTFFFTAATADDFTT FFDTAAAADAFFDFFFAADTFADTTAFDDDDTDDFFATDTFTFTTAAFTDDFDDDATFADADDTD
TAVARUS SWAIN MORGAN MEDICAL CENTER
1861 GREY LAND RD PO BOX 860
GREENSBORO GA 30642-5039 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354835 TAVARUS SWAIN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/29/24 - 07/30/24) TAVARUS SWAIN
Provider: Chhabra, Anil Kumar MD
07/29/2024 PHARMACY $12.00
07/29/2024 LABORATORY $133.00
07/29/2024 LAB/IMMUNOLOGY $85.00
07/29/2024 LAB/BACT-MICRO $326.00
07/29/2024 EMERG ROOM $1,943.00
07/30/2024 LAB/UROLOGY $36.00
07/30/2024 EMERG ROOM $188.00
07/30/2024 DRUGS/DETAIL CODE $48.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$2,771.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878243} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8124515605
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354832 Upon Receipt $0.00 $
Page 1 of 1
FTATTDFFAFDATFTDTDAAFAFAFFTTFTAFFTDDDTFDTFATADDTAFADDDTFDAFAATFFD TFFAAAFFTTFDFTDFDATDAADFATADADDDTFAFDADFDDFDAFAFFTFTTDFTATTTDDADD
PEGGY M WALKER MORGAN MEDICAL CENTER
304 ARROWHEAD TRL PO BOX 860
WARNER ROBINS GA 31088-5332 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354832 PEGGY M WALKER 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/16/24) PEGGY M WALKER
Provider: Cannington, Sara Danielle FNP
07/16/2024 CLINIC $130.00
07/16/2024 PRO FEE/CLINIC $176.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878258} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8005532953
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354831 Upon Receipt $0.00 $
Page 1 of 1
ATDAAFAAFFFAATTTAAADDDDATFFDTFFADTATFDFFATAFFDFTDTATADDDTFAFDTDTT ADTFFDATATAAATFTFTATTFTADTTADFADATFTTFDDFDTAFTFDDTTDTDADTADTTTFFF
JREESE N COLBERT MORGAN MEDICAL CENTER
1060B MICHA CIR PO BOX 860
MADISON GA 30650-2095 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354831 JREESE N COLBERT 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/25/24) JREESE N COLBERT
Provider: Chhabra, Anil Kumar MD
07/25/2024 LABORATORY $133.00
07/25/2024 LAB/IMMUNOLOGY $85.00
07/25/2024 EMERG ROOM $1,628.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,846.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878269} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7862911233
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354829 Upon Receipt $0.00 $
Page 1 of 1
TFDADTTFTFTFFDDFFFTTAAFTADTATDATFDDAAATDDTFTTTAADFTTDFTDFTAAADDDD ATDTDFTAFDDADAATAFTADDFATFTDDATFDTDDAAATAAATFTTTTADFFAAADAFATAFTA
JOE R FOX MORGAN MEDICAL CENTER
1051 WESTMINSTER WAY PO BOX 860
MADISON GA 30650-4287 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354829 JOE R FOX 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/30/24) JOE R FOX
Provider: Zant Jr, Walter Daniel MD
07/30/2024 CT SCAN/HEAD $1,545.00
07/30/2024 Patient payment -$300.00
Patient Balance -$300.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,545.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: .............-$300.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878282} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629582
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354828 Upon Receipt $0.00 $
Page 1 of 1
AFDTFFFFADFTFATDDDTFTFTDTDADATAFADTDTDFATAFTTTFTFAFFDFDFFFFFTDFTA TAADTTDDDDTDTATFTDAFFTAFFFAAATFFFFTAFFAATADFAFDFAAAAFAFFFTAADFTAT
JORGE GHIGLIONE MORGAN MEDICAL CENTER
21331 SW 246TH ST PO BOX 860
HOMESTEAD FL 33031-3654 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354828 JORGE GHIGLIONE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/30/24) JORGE GHIGLIONE
Provider: McAlpine, Steven B MD
07/30/2024 DRUGS/INCIDENT RAD $500.00
07/30/2024 NON-STER SUPPLY $31.48
07/30/2024 STERILE SUPPLY $7.76
07/30/2024 LAB/CHEMISTRY $87.00
07/30/2024 LAB/HEMATOLOGY $64.00
07/30/2024 LAB/UROLOGY $6.00
07/30/2024 CT SCAN/BODY $1,381.00
07/30/2024 EMERG ROOM $2,511.00
07/30/2024 DRUGS/DETAIL CODE $44.02
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$4,632.26
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878295} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7936742216
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354826 Upon Receipt $0.00 $
Page 1 of 1
DATAFADDADTTTTTFDDDAFADFADTFFTFTTDDTFATADDTATDDADAAAFADADFTFDFADD DAATFADDFADTTFDDTDDDFDTDAFDFADTAFFADFDFATTADTDAAAFFADFTAFTFDFFATF
MIKE K FOSTER MORGAN MEDICAL CENTER
1070 MICHA WAY APT 124 PO BOX 860
MADISON GA 30650-6100 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354826 MIKE K FOSTER 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/30/24) MIKE K FOSTER
Provider: Werkin, Jacob MD
07/30/2024 CLINIC $130.00
07/30/2024 PRO FEE/CLINIC $176.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878308} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8091817012
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354824 Upon Receipt $0.00 $
Page 1 of 1
FFDFDTTTFFDTTTFFDAFTAAATDTTTDDADAFAFAAATDADAATTAFAAAATTAATTFADAAD FTDDADTADATFDFFAAFFTDTDTDFFTDFFADTFAATFTATDADAFDTFTFFFDFDAADAAFAD
LUTHER WAKEFIELD MORGAN MEDICAL CENTER
1460 STACI DR PO BOX 860
GREENSBORO GA 30642-2504 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354824 LUTHER WAKEFIELD 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/15/24) LUTHER WAKEFIELD
Provider: Pepper, Robert Thomas MD
07/15/2024 LABORATORY $5.00
07/15/2024 LAB/CHEMISTRY $25.00
07/15/2024 LAB/HEMATOLOGY $92.00
07/15/2024 PRO FEE/OUTPT $390.08
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$512.08
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878319} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7976627238
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354823 Upon Receipt $0.00 $
Page 1 of 1
DATDDAAFDTADDATFDTFFATDTAAFFDTTFFDATAAFTAAFAADDFATDATTFATFFDDFDFF FDTATFATTFFFADAAFTDATAATTTFFDADTATDFTDTDFFFTDATTDDDDATDTTATFATDDT
TERRI R HENRY MORGAN MEDICAL CENTER
1060 MATTHEW LN PO BOX 860
MADISON GA 30650-4525 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354823 TERRI R HENRY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/29/24) JACOB L HENRY
Provider: Chhabra, Anil Kumar MD
07/29/2024 PHARMACY $36.00
07/29/2024 LABORATORY $335.00
07/29/2024 LAB/CHEMISTRY $468.00
07/29/2024 LAB/HEMATOLOGY $105.00
07/29/2024 EMERG ROOM $2,258.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$3,202.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878326} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7884214663
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354816 Upon Receipt $0.00 $
Page 1 of 1
FAADAAATADAAFFDDDTATFDDFTDTDADAATDTTFTADADFFAFDAFDADFTDTADTATDTFT DFFFDTFFAFATFDTDDAFFAFFDFTDTATATTFTTDTTFDFTFTDDAFDATATTDADDFFDAFA
JOANNE R SHY MORGAN MEDICAL CENTER
954 N MAIN ST PO BOX 860
MADISON GA 30650-1451 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354816 JOANNE R SHY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/02/24) JOANNE R SHY
Provider: Wingate III, Harry Lynnwood MD
07/02/2024 EMERG ROOM $2,131.00
07/02/2024 DRUGS/DETAIL CODE $25.15
07/16/2024 Medicare payment -$979.64
07/16/2024 Contractual Allowance Adjustment -$1,076.51
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$2,156.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: .....-$2,056.15
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878340} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8118275482
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354814 Upon Receipt $0.00 $
Page 1 of 1
AFTDFAAFFAAAAFTFAATDATTTAAATFTADDFDTDDFFDDATTAFAADTDDDTDAAATADADD AFDDDTAAFDAADAADAAAAFFAADATADTADFDDTAFTTFAAAATDATTTFDTAFTAFATDDAA
EMORY GARY STEWART MORGAN MEDICAL CENTER
1170 SULGRAVE DR PO BOX 860
MADISON GA 30650-4614 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354814 EMORY GARY STEWART 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/17/24) EMORY G STEWART
Provider: Pepper, Robert Thomas MD
07/17/2024 LABORATORY $151.00
07/17/2024 LAB/IMMUNOLOGY $17.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$168.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878346} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629155
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354811 Upon Receipt $0.00 $
Page 1 of 1
DTFDTDFAAFAAAFAATADTDDTTTFAAFFAADATDFFAFTTFDFFTDADTTDDDDADFFTTTFD TDATTFFDDDFDTATATTTFDAFFAAADAADDDATFFATADAFDFFTTATFAFTFAADAADTATT
DAKOTA W PEDEN MORGAN MEDICAL CENTER
943 HARPER ST PO BOX 860
MADISON GA 30650-1474 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354811 DAKOTA W PEDEN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/01/24 - 07/31/24) DAKOTA W PEDEN
Provider: Ashford, William MD
07/03/2024 PHYSICAL THERAPY $185.00
07/08/2024 PHYSICAL THERAPY $185.00
07/11/2024 PHYSICAL THERAPY $185.00
07/16/2024 PHYSICAL THERAPY $185.00
07/18/2024 PHYSICAL THERAPY $185.00
07/23/2024 PHYSICAL THERAPY $266.00
07/25/2024 PHYSICAL THERAPY $187.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,378.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878354} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8111442342
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354809 Upon Receipt $0.00 $
Page 1 of 1
AFATDFFDTTTFAFADTTAFFDFTFDFTFTFFDTFTDDDTADFDTDDTTFDDTADDFFDFDAAFT TTFFADDFTTTDFTDADFADTTTFFDAAAFFFAAAADFFFTDDFFFFTFAATAFFDFTTTDATFD
BRANDON SAMPSON MORGAN MEDICAL CENTER
1241 SHEPARD RD PO BOX 860
MADISON GA 30650 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354809 BRANDON SAMPSON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/12/24) BRANDON SAMPSON
Provider: Pepper, Robert Thomas MD
07/12/2024 PRO FEE/CLINIC $470.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$470.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878366} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8079242633
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354808 Upon Receipt $0.00 $
Page 1 of 1
FTAFDDFFFFADTTAATTAFTTTTFTDDDADFFTDFDAAAAATAFTATDTFFADFFTFTDDAADA AATAFATTATDAATFDFDTTADDATDTDDDTFTDFDTAFDADATATAFDADDAFATDADTTFFDF
WILLIAM D MEDLOCK MORGAN MEDICAL CENTER
2340 DIXIE HWY PO BOX 860
MADISON GA 30650-3520 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354808 WILLIAM D MEDLOCK 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/22/24) WILLIAM D MEDLOCK
Provider: Pepper, Robert Thomas MD
07/22/2024 CLINIC $130.00
07/22/2024 PRO FEE/CLINIC $356.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$486.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878379} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629573
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354805 Upon Receipt $0.00 $
Page 1 of 1
TAAFDAFFADDFDFDDDTFDFDAFATDFFDDATDTTFFDAFFDFTFTADFDADDFADTTTFDFAD ATADFDDTFTTTAAFTTDATDDDFDFTTFFAFDTATAAFFATAFFTFDAATTFFADFFFTTATAF
JEFF HULSEY MORGAN MEDICAL CENTER
8330 SHADOW CREEK DR PO BOX 860
BETHLEHEM GA 30620-4716 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354805 JEFF HULSEY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/22/24) JEFF HULSEY
Provider: Spencer, Dennis DO
07/22/2024 DRUGS/INCIDENT RAD $500.00
07/22/2024 LABORATORY $146.00
07/22/2024 LAB/HEMATOLOGY $64.00
07/22/2024 CT SCAN $1,188.00
07/22/2024 CT SCAN/HEAD $1,545.00
07/22/2024 CT SCAN/BODY $4,170.00
07/22/2024 EMERG ROOM $2,761.00
07/22/2024 DRUGS/DETAIL CODE $24.00
07/22/2024 Patient payment -$50.00
Patient Balance -$50.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$10,398.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$50.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878391} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629153
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354802 Upon Receipt $0.00 $
Page 1 of 1
FTADDFDTFTFDTDDAAFADTDTDFFFFTAAFTAAAATDTFDATDFDTFTAADFFADFFATAADA TADTAATFDTDFFADFAFTDFTTAAFAFTDDFFFFFFAFDTTFTAFAFTAFDDFFTDTATDFDTD
BRANDI P GALLINA MORGAN MEDICAL CENTER
529 PALIMINO PASS PO BOX 860
MONROE GA 30655-2769 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354802 BRANDI P GALLINA 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/22/24) BRANDI P GALLINA
Provider: TARRACCIANO, STEPHANIE MARY DO
07/22/2024 ULTRASOUND $257.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$257.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878409} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8091615947
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354801 Upon Receipt $0.00 $
Page 1 of 1
FADFDAFDDTFTAFFFDFDDATTFFDFTDDTFDFFDDTDDTTAFTDTADTDTTAFTFFAAFFAFA TFTFTTADTDAFTTTFFTAFAAFAFTATTTFDTFDADFTTDFDAAFDFDTAFTTFFTDTADDFFT
THERESA CHESTER MORGAN MEDICAL CENTER
1181 LICK SKILLET RD PO BOX 860
GREENSBORO GA 30642-2124 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354801 THERESA CHESTER 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/01/24) THERESA CHESTER
Provider: Brown, Kirk Tahama MD
07/01/2024 DRUGS/INCIDENT RAD $500.00
07/01/2024 IV SOLUTIONS $44.02
07/01/2024 NON-STER SUPPLY $31.48
07/01/2024 STERILE SUPPLY $45.56
07/01/2024 LABORATORY $268.50
07/01/2024 LAB/CHEMISTRY $357.00
07/01/2024 LAB/IMMUNOLOGY $17.00
07/01/2024 LAB/HEMATOLOGY $64.00
07/01/2024 CT SCAN/HEAD $1,545.00
07/01/2024 CT SCAN/BODY $1,381.00
07/01/2024 EMERG ROOM $2,558.00
07/01/2024 DRUGS/DETAIL CODE $82.00
07/01/2024 EKG/ECG $154.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$7,047.56
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878431} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629571
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354800 Upon Receipt $0.00 $
Page 1 of 1
TDTDDDAATFFDDTATTFDDTTFAADDADFDTADDDAATATTFFTDATAFFADAATAFTDDFTTF ADFADFFAADFTDTATDATATFAFTTTFFATDATTDTATAFFADFTTTFTDATTAAAFDATTTDA
DAVID CAMMARATA MORGAN MEDICAL CENTER
17418 PALMETTO PASS LN PO BOX 860
PUNTA GORDA FL 33982-5114 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354800 DAVID CAMMARATA 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/12/24) DAVID CAMMARATA
Provider: Chhabra, Anil Kumar MD
07/12/2024 PHARMACY $24.78
07/12/2024 ULTRASOUND $552.00
07/12/2024 EMERG ROOM $1,943.00
07/12/2024 DRUGS/DETAIL CODE $12.00
08/02/2024 Commercial insurance payment -$483.16
08/02/2024 Contractual Allowance Adjustment -$632.94
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$2,531.78
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: .....-$1,116.10
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878444} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8116668745
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354799 Upon Receipt $0.00 $
Page 1 of 1
DFAFAATFFTTDTTFFADTAFFATATFATDADADFDAAFTADDTAFDATFDFFAAFFTAAAFAFA DDDTDFAFFFFAFFTTAADFDFATAADFTATTFADDFTTDDAATDDTTTDFDDTTTTTFFFTFTA
GRADY F BUTLER MORGAN MEDICAL CENTER
1030 BLUE SPRINGS CT PO BOX 860
BUCKHEAD GA 30625-2000 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354799 GRADY F BUTLER 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/23/24) GRADY F BUTLER
Provider: Werkin, Jacob MD
07/23/2024 STERILE SUPPLY $74.12
07/23/2024 CLINIC $130.00
07/23/2024 PRO FEE/CLINIC $599.52
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$803.64
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878455} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629570
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354797 Upon Receipt $0.00 $
Page 1 of 1
TDADTFDDAADAFDTTAFFTDTTFTFTDAFATFAFAAAFFTDDTDDDTDFADAFFTFTFFDAFFT FFADTTFTDFADAFAFTTFAFAFDDAFTFTFTDDTAADTFFAFFTADAADTTDTDDAFAFADAAT
TERRY CALLAWAY MORGAN MEDICAL CENTER
1950 CEDAR GROVE RD PO BOX 860
BUCKHEAD GA 30625-1826 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354797 TERRY CALLAWAY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/21/24) WILLIAM CALLAWAY
Provider: Cannington, Sara Danielle FNP
06/21/2024 LABORATORY $151.00
06/21/2024 LAB/CHEMISTRY $266.00
06/21/2024 LAB/HEMATOLOGY $64.00
06/21/2024 PRO FEE/CLINIC $312.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$793.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878474} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8094530736
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354796 Upon Receipt $0.00 $
Page 1 of 1
ATDAFFTTDFTDDFDTDFTTTDFAAFDDDADAFADDFDFTTFAFDAATTFAADADADAFADAAFA FAFAAADATADDDDFFDFDTATTDTDFFFDDAADAFTTFAADDDTAAFFFDATFDAFFTDAFTDD
JAMIYHA SCOTT MORGAN MEDICAL CENTER
1200 WHEAT ST APT 308 PO BOX 860
MADISON GA 30650-1167 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354796 JAMIYHA SCOTT 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/01/24) JAMIYHA SCOTT
Provider: Brown, Kirk Tahama MD
07/01/2024 IV SOLUTIONS $44.02
07/01/2024 LABORATORY $146.00
07/01/2024 LAB/HEMATOLOGY $64.00
07/01/2024 EMERG ROOM $2,511.00
07/18/2024 Commercial insurance payment -$750.01
08/01/2024 Medicaid payment -$249.33
07/18/2024 Contractual Allowance Adjustment -$865.03
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$2,765.02
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: .....-$1,864.37
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878487} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629450
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354795 Upon Receipt $0.00 $
Page 1 of 1
AAADFTTAFDDDADTFFDTAAFFATFFTTDDATFFDDATDAAFATFDFAFDDTADDDDFATFTFT DTTFFDTDAATATDDTFDFDTDDTFDDTTFAATAFTDDFTTDAADDFTDFAFAFTFDDDDFADFF
JILL C GRESHAM MORGAN MEDICAL CENTER
2340 BETHANY RD PO BOX 860
MADISON GA 30650-4704 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354795 JILL C GRESHAM 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/31/24) JILL C GRESHAM
Provider: BOULWARE, RONALD
07/31/2024 SCRN MAMMOGRAPHY $298.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$298.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878500} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629569
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354792 Upon Receipt $0.00 $
Page 1 of 1
FFAFTTAFFTDAFAFDDFAAAADDATATADAFFFFDFTDFFTAAAFTFDDTDTATDFDDDTDTFA TTTATFTDTDDFTTTAFDTFTTFAADADTADFTADFDFATTFFTFFTDDAFFTAFADTTADAFDT
FRANCES S STONECYPHER MORGAN MEDICAL CENTER
PO BOX 1083 PO BOX 860
MADISON GA 30650-8083 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354792 FRANCES S STONECYPHER 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/26/24) FRANCES S STONECYPHER
Provider: Zant Jr, Walter Daniel MD
06/26/2024 DX X-RAY $460.00
07/16/2024 Medicare payment -$144.26
07/16/2024 Contractual Allowance Adjustment -$223.74
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$460.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ........-$368.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878516} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8111442345
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354791 Upon Receipt $0.00 $
Page 1 of 1
FTATFDDADDTTFFAAATDATAAFDDTDFATFTTDFDTADTFTDFFDDTFATFFADDFFADADTD AAFFDTDAADTTDTADDFAAADAFDDTAFTAFADTTTAAAAFTFATDAFATAAAAFFADATFAFA
SHIREE R NATION MORGAN MEDICAL CENTER
2654 SANDY CREEK RD PO BOX 860
MADISON GA 30650-3214 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354791 SHIREE R NATION 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/01/24 - 07/31/24) SHIREE R NATION
Provider: GREEN, BRYAN
07/01/2024 PHYSICAL THERAPY $185.00
07/08/2024 PHYSICAL THERAPY $185.00
07/10/2024 PHYSICAL THERAPY $185.00
07/15/2024 PHYSICAL THERAPY $185.00
07/17/2024 PHYSICAL THERAPY $183.00
07/24/2024 PHYSICAL THERAPY $185.00
07/29/2024 PHYSICAL THERAPY $252.00
07/10/2024 Patient payment -$60.00
07/17/2024 Patient payment -$40.00
07/24/2024 Patient payment -$20.00
07/30/2024 Patient payment -$20.00
Patient Balance -$140.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,360.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: .............-$140.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878530} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7879614271
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354790 Upon Receipt $0.00 $
Page 1 of 1
AAFATTDTDATDDFTDFDTTFFTFDDTTTTFFDDDAATDATADTTAAATATAAAAAFDFADFFTF AFATFAFTFTFTAAFDTTTTFFDFTATDFDTDDDADAFDFFTADATAFATDTFDATAAFTTDTTF
MARGARET R RIGSBY MORGAN MEDICAL CENTER
2761 MONTICELLO RD PO BOX 860
MADISON GA 30650-4859 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354790 MARGARET R RIGSBY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/10/24) MARGARET R RIGSBY
Provider: Cossio, Miguel Eduardo MD
07/10/2024 SCRN MAMMOGRAPHY $298.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$298.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878541} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8175479628
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354789 Upon Receipt $0.00 $
Page 1 of 1
FDFFAFDAFATFDTADFFTDFFTAAFDAFTFATTDTTATDDTTDAFATDDATAFAFAFAATAAFD TDDDADAFDTAFFADAAAADDATAFAAATFFDDAFAFFDDDTFAFFFDTTADDDFDTTATDTDAD
LARA S PERRY MORGAN MEDICAL CENTER
281 SMITHBORO RD PO BOX 860
MONTICELLO GA 31064-5626 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354789 LARA S PERRY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/22/24) LARA S PERRY
Provider: Cannington, Sara Danielle FNP
07/22/2024 PRO FEE/OUTPT $306.15
07/22/2024 Patient payment -$15.00
Patient Balance -$15.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$15.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878552} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629568
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354787 Upon Receipt $0.00 $
Page 1 of 1
FFDTFTDAFATAFFTDFDAFFFADAAFTFTATADFDFADFDFFFAATFFATTAAFDFTDAAFFTD FDFFADFATAADDDFADAFTTATDDTFAFFFTTTAATDDAFDFFDAFTFDTAADDFAATDATTFD
PHOEBE I PINCUS MORGAN MEDICAL CENTER
1181 BROOKS RD PO BOX 860
MADISON GA 30650-2278 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354787 PHOEBE I PINCUS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/27/24) PHOEBE I PINCUS
Provider: Cossio, Miguel Eduardo MD
06/27/2024 DX X-RAY/CHEST $173.00
07/16/2024 Medicare payment $39.22
07/16/2024 Contractual Allowance Adjustment -$83.04
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$173.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ..........-$43.82
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878564} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7930731847
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354786 Upon Receipt $0.00 $
Page 1 of 1
DFTDAATDDATTTTDFATTFAFTAATDDFTTAAFAFAFDTTFDFADTFTDAADAFAFDAADDFTD DFTAFAADAAFATDDDFTDDAFDTATDDTDTTAFFDDTDTDDTTTDAFDDFFADTATTDDFDFDF
DOROTHY ANN BRADLEY MORGAN MEDICAL CENTER
107 KELLY ST PO BOX 860
RUTLEDGE GA 30663-2983 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354786 DOROTHY ANN BRADLEY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/09/24) DOROTHY A BRADLEY
Provider: Cannington, Sara Danielle FNP
07/09/2024 CLINIC $130.00
07/09/2024 PRO FEE/CLINIC $176.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878576} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8114860591
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354785 Upon Receipt $0.00 $
Page 1 of 1
DDTDAFTTATDFTFFAADDADFFFTFDDDATTFATFDDDTFDTTDTFTFFFFTFFADFFAFTAFA DADDDTTFFFTAFFTDAFFFFDATFFDATTAADFDTFDADTAAATDDATFADDATDDTFFFFFAA
KRISTIN P ROTON MORGAN MEDICAL CENTER
1030 ARBOR LN PO BOX 860
MADISON GA 30650-3784 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354785 KRISTIN P ROTON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/29/24) KRISTIN P ROTON
Provider: BOULWARE, RONALD
07/29/2024 LABORATORY $197.00
07/29/2024 LAB/CHEMISTRY $297.00
07/29/2024 LAB/HEMATOLOGY $64.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$558.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878594} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7901816098
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354784 Upon Receipt $0.00 $
Page 1 of 1
DDFDTFDFTFFFAAFATTATTDDFFDFFFAATATADAAAFAFTFFFADATFTATADDTADDTADT FTATTFDTDFDDAFAATDDADTFDTFFDFADAFTTFATAFAAFDDATTAFDTDADTFFAFAAATT
CHARLENE ROSS BROWN MORGAN MEDICAL CENTER
325 PARKWAY PL PO BOX 860
MONROE GA 30655-3102 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354784 CHARLENE ROSS BROWN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/27/24) CHARLENE R BROWN
Provider: Cannington, Sara Danielle FNP
06/27/2024 LABORATORY $151.00
06/27/2024 LAB/CHEMISTRY $245.75
06/27/2024 LAB/HEMATOLOGY $64.00
06/27/2024 PRO FEE/CLINIC $470.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$930.75
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878617} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629352
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354782 Upon Receipt $0.00 $
Page 1 of 1
FFDAAFTATDAAFFDTFTDAFTATDFAFDTTDFTTAFAAAFDTAAADFFDTATADAFFATAFADA ADAAAFFTTTFDATFADTTTTADFTTADFFDDATAFTADFFDFDFAATFTDTADFTAATTTTADD
JESSICA A BROWN MORGAN MEDICAL CENTER
1679 OLD HILLSBORO RD PO BOX 860
FRANKLIN TN 37069-4745 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354782 JESSICA A BROWN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/23/24) JESSICA A BROWN
Provider: Pepper, Robert Thomas MD
07/23/2024 PRO FEE/CLINIC $351.52
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$351.52
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878630} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629562
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354781 Upon Receipt $0.00 $
Page 1 of 1
TDFDFFFTTDAFDTDTAAAATDTADTFAFFTDDTFTDTAAFTAFDAFDDDAAATAFTFTATTTAT TFDFFTAFATAAFTDDFAADAFTAFTTATDADTFFTDFDDDDTAADFFDTADTDADTTDTDDFFF
MARCELLA BELTON MORGAN MEDICAL CENTER
1600 BETHANY RD UNIT 2012C PO BOX 860
MADISON GA 30650-4786 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354781 MARCELLA BELTON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/16/24) MARCELLA BELTON
Provider: Cannington, Sara Danielle FNP
07/16/2024 LABORATORY $5.00
07/16/2024 LAB/CHEMISTRY $127.00
07/16/2024 CLINIC $130.00
07/16/2024 PRO FEE/CLINIC $176.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$438.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878640} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8121087784
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354779 Upon Receipt $0.00 $
Page 1 of 1
AATTAAFTADFADAFDDTTTFTADTFDDTTDFTDTTFDTTFTFAAAFFFTFADTFFTDTDTDDFT TATTDATDFDDATATDADTFFDFAAFTDTTTFFFDDFAATTAATADTFTAFFDAAADTFADFFTA
ANGELINE L WILLIAMS MORGAN MEDICAL CENTER
1011 BLUE SPRINGS CT PO BOX 860
BUCKHEAD GA 30625-2034 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354779 ANGELINE L WILLIAMS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/29/24) ANGELINE L WILLIAMS
Provider: Cannington, Sara Danielle FNP
07/29/2024 ULTRASOUND $257.00
07/29/2024 Patient payment -$123.93
Patient Balance -$123.93
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$257.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: .............-$123.93
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878652} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8008842221
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354778 Upon Receipt $0.00 $
Page 1 of 1
FADFTAATAFFAFFADTAFDADAFTAATTTFAFFFAADADTDDAATTFTTDDFTADTFDFTFDDF ATFDTDDADDTDDAAATFAADTAFDFAAFAFFDTTAAFAAAADFFADTAATAFAFFFAAATAAAT
TONYA L JEFFRIES MORGAN MEDICAL CENTER
2801 OLD BUCKHEAD RD PO BOX 860
MADISON GA 30650-4240 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354778 TONYA L JEFFRIES 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/09/24) TONYA L JEFFRIES
Provider: Werkin, Jacob MD
07/09/2024 PRO FEE/CLINIC $351.52
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$351.52
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878668} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629561
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354776 Upon Receipt $0.00 $
Page 1 of 1
FTDATFATFTATDFDTDAATTDAAADDFDAFFAADTATFTADFTDAFTADAFFTFAAADDDTFDF DTDFTDTFTFTFFDTAFFFFTTATFDFATAFATADADDADTFDADFDTDFADTADDDDTFFAFFT
CYNTHIA BRAGG MORGAN MEDICAL CENTER
359 WALKER ROSE LN PO BOX 860
MADISON GA 30650-1384 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354776 CYNTHIA BRAGG 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/27/24) CYNTHIA BRAGG
Provider: BOULWARE, RONALD
07/27/2024 LABORATORY $363.00
07/27/2024 LAB/CHEMISTRY $75.00
07/27/2024 LAB/HEMATOLOGY $64.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$502.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878685} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8169249656
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354775 Upon Receipt $0.00 $
Page 1 of 1
TFTDFTAAFTADDTFFDTAAFDFADATFTTTTFFDATTATFAFTATDFDTDAFDTFAAFADDTAD FAAADADTAFDTADADDDDAADFDTDDDFTTAADTDTDAFAFTDTTTAFFDTTATTFFDFAFADA
CONNIE L ZACHARY MORGAN MEDICAL CENTER
3621 ENTERPRISE RD PO BOX 860
MADISON GA 30650-5603 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354775 CONNIE L ZACHARY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/31/24 - 08/01/24) CONNIE L ZACHARY
Provider: Gallo, Martin Robert MD
07/31/2024 PHARMACY $180.00
07/31/2024 MED-SUR SUPPLIES $41.84
07/31/2024 NON-STER SUPPLY $31.48
07/31/2024 STERILE SUPPLY $210.20
07/31/2024 LAB/CHEMISTRY $76.00
07/31/2024 PATHOL/HYSTOL $138.00
07/31/2024 OR SERVICES $21,400.00
07/31/2024 ANESTHESIA $5,383.84
07/31/2024 DRUGS/DETAIL CODE $246.09
07/31/2024 RECOVERY ROOM $2,214.00
07/31/2024 OBSERVATION RM $1,379.00
07/31/2024 PRO FEE/ANES CRNA $1,467.00
07/31/2024 PRO FEE/OR $3,906.16
08/01/2024 PHARMACY $48.00
08/01/2024 LAB/HEMATOLOGY $64.00
08/01/2024 DRUGS/DETAIL CODE $48.00
08/01/2024 OBSERVATION RM $1,379.00
07/31/2024 Patient payment -$95.00
Patient Balance -$95.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$38,212.61
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$95.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878696} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7863211472
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354774 Upon Receipt $0.00 $
Page 1 of 1
TTFDFDAFTDADFTAAFAAFDTTFDDTAAADATAAAAAFFADFAFTADATDDFTFTTTTAATDTF FFFDFTFAFAATDFFDTAFTFFTDDADAFDATDDATATDAFTAFTTFFADTADDTFAFFDADTAF
COLEMAN TAYLOR MORGAN MEDICAL CENTER
1190 BELL CIR PO BOX 860
MADISON GA 30650-2052 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354774 COLEMAN TAYLOR 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/24/24) COLEMAN TAYLOR
Provider: Spencer, Dennis DO
07/24/2024 LABORATORY $340.25
07/24/2024 LAB/CHEMISTRY $85.00
07/24/2024 LAB/IMMUNOLOGY $85.00
07/24/2024 LAB/HEMATOLOGY $164.00
07/24/2024 CT SCAN $1,188.00
07/24/2024 CT SCAN/HEAD $1,545.00
07/24/2024 EMERG ROOM $2,658.00
07/24/2024 DRUGS/DETAIL CODE $116.02
07/24/2024 EKG/ECG $154.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$6,335.27
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878711} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7866212815
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354773 Upon Receipt $0.00 $
Page 1 of 1
FFDFTTATDDFDDFTDDATFATFDFTATADADFFATDFFTDATFAFTAADFAFTDFAAFDADAFD DDTTAFADDAFFTFDAATDDDADTAAFDTFDTFAFFFDDTDTDTDFATTDFFFDDATDADFTDTD
MILAGROS J JASUTIS MORGAN MEDICAL CENTER
1101 CREEKWOOD CIR PO BOX 860
MADISON GA 30650-5077 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354773 MILAGROS J JASUTIS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/18/24) MILAGROS J JASUTIS
Provider: ELMORE, STEPHEN
07/18/2024 DX X-RAY $504.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$504.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878725} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7939947795
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354772 Upon Receipt $0.00 $
Page 1 of 1
ADTFDFTADATDFFTAFFTDDATTFFDFDAADFATTTFDFFFDDFTFTDAADFAADFDTAFTTFF TDTDDDADFDAATATTATAFDFFAFATTTAADFADTFFTTDATAFDDDTTAFDTAFTTFADTFAA
WILLIAM R SNOWDEN III MORGAN MEDICAL CENTER
1440 DAVIS ACADEMY RD PO BOX 860
MADISON GA 30650-4122 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354772 WILLIAM R SNOWDEN III 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/23/24 - 07/31/24) WILLIAM R SNOWDEN
Provider: Colasurdo, Joseph Nicholas DPM
07/23/2024 PHYSICAL THERAPY $124.00
07/23/2024 PHYS THERP/EVAL $190.00
07/26/2024 PHYSICAL THERAPY $183.00
07/29/2024 PHYSICAL THERAPY $183.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$680.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878739} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7968499236
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354771 Upon Receipt $0.00 $
Page 1 of 1
FFTAATADFTAADAFFATDDFDTDFATFDDFTDDTDAAAAFFDTTDAFFTFAFTFATADDDDADA AFFTTAFADDFDDAAFTATAFAAFTAAFFTDDDDTFAATAFAFDAATAATDAFTFAAAAATDATT
CAROLYN L SMITH MORGAN MEDICAL CENTER
2610 COCHRAN RD PO BOX 860
MADISON GA 30650-5510 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354771 CAROLYN L SMITH 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/15/24) CAROLYN L SMITH
Provider: Cannington, Sara Danielle FNP
07/15/2024 CLINIC $130.00
07/15/2024 PRO FEE/CLINIC $176.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878755} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8014657338
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354770 Upon Receipt $0.00 $
Page 1 of 1
TATFFTAAAFFFADTDAATFADADDATDTDTFDDFDFAFDAFTTADDADDTTFDADAFTAAFAFF AAAFATDTTTTDATFFDDATATDFDDATFDFFADAATFFFADDFAAFFFATTAFFDFATTTFTFD
GLENDA K WHITE MORGAN MEDICAL CENTER
1210 WESTMINSTER WAY PO BOX 860
MADISON GA 30650-4298 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354770 GLENDA K WHITE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/02/24) GLENDA K WHITE
Provider: Socoloff, David Neal DO
08/02/2024 PHARMACY $24.00
08/02/2024 MED-SUR SUPPLIES $41.84
08/02/2024 NON-STER SUPPLY $31.48
08/02/2024 STERILE SUPPLY $31.92
08/02/2024 OR SERVICES $1,751.00
08/02/2024 ANESTHESIA $1,105.61
08/02/2024 DRUGS/DETAIL CODE $106.05
08/02/2024 RECOVERY ROOM $1,194.00
08/02/2024 PRO FEE/ANES CRNA $1,467.00
08/02/2024 PRO FEE/OR $1,009.00
08/02/2024 Patient payment -$325.00
Patient Balance -$325.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$6,761.90
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: .............-$325.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878766} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7907016512
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354768 Upon Receipt $0.00 $
Page 1 of 1
DTFDAFDFATTDTFTAFDTFDTFFTFAFAFTAATDFDDATATTFDFADAADFTFFFFDFAAADAD TTDAFFTFATDAFTDTFFTDTDTAADTFTFTFTAFDDAFDTDTTFDADDAFDAFATDDDTDADDF
NIKETA R HAWKINS MORGAN MEDICAL CENTER
1200 WHEAT ST APT 208B PO BOX 860
MADISON GA 30650-1166 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354768 NIKETA R HAWKINS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/16/24) NIKETA R HAWKINS
Provider: Cannington, Sara Danielle FNP
07/16/2024 LABORATORY $497.50
07/16/2024 LAB/CHEMISTRY $404.00
07/16/2024 LAB/HEMATOLOGY $64.00
07/16/2024 PRO FEE/CLINIC $334.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,299.50
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878780} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7863911928
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354767 Upon Receipt $0.00 $
Page 1 of 1
ADAADDDAAFTDDTAAATDTTFFFTFTFFATTFTFDDFATFDTAFFDTFATDFTDFDFAADFTDF FTFTFFDAFADTDFFTTFDTDDTDTFDFFFTADTADATFAATTDDTADAFDAFFTAFAFDAAATF
MARSHAE L JOHNSON MORGAN MEDICAL CENTER
215 E COUNTRY WOODS DR PO BOX 860
COVINGTON GA 30016-4583 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354767 MARSHAE L JOHNSON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/23/24) MARSHAE L JOHNSON
Provider: Spencer, Dennis DO
07/23/2024 EMERG ROOM $1,313.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,313.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878793} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8064294381
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354766 Upon Receipt $0.00 $
Page 1 of 1
FDTDDDTDFFFAAFDAADTFTFTFADATDFTFFTDTDFDDATAADAFTTADTFDFTFADFTTADT DATDATTDDATFTFDFADFDFTDTFFFTTDFAFFFAFDFTTTFATFFATFAFFFDFDTADFFDAD
JAMES W DUKES MORGAN MEDICAL CENTER
254 FAIRPLAY ST PO BOX 860
RUTLEDGE GA 30663-2330 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354766 JAMES W DUKES 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/18/24) JAMES W DUKES
Provider: Cannington, Sara Danielle FNP
07/18/2024 LABORATORY $151.00
07/18/2024 LAB/CHEMISTRY $167.75
07/18/2024 LAB/HEMATOLOGY $64.00
07/18/2024 CLINIC $130.00
07/18/2024 PRO FEE/CLINIC $176.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$688.90
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878809} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7948061383
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354765 Upon Receipt $0.00 $
Page 1 of 1
AFTDTAFDTTDTDTDDDFADFFFAFAFADDDTADFFTFDAAAFATADAATTAFDFADAFTFDDTD DFDATAAFTFFFFDTFFADFAAATATFFTTDTTFDFDTTDDFDTTFTADDFDATDTTDTFFDFDT
KIMBERLY M NELSON MORGAN MEDICAL CENTER
1081 CREEK PT PO BOX 860
MADISON GA 30650-7007 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354765 KIMBERLY M NELSON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/24/24) KIMBERLY M NELSON
Provider: Cannington, Sara Danielle FNP
07/24/2024 PRO FEE/OUTPT $224.93
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$224.93
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878825} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629554
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354763 Upon Receipt $0.00 $
Page 1 of 1
DDATADATFTADTFTTATTFTDFTTAADFFDDAAADATFADFFADAFDATTADTDFTAADFTADT FDAFDDFTAFATADATDTFATFFDDTDAFAATTTTTTTTFFFTFDTDTFDTTATTDAFDFATAFA
ANNAMARIE MINTURN MORGAN MEDICAL CENTER
1071 HAWTHORNE CIR PO BOX 860
MADISON GA 30650-5098 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354763 ANNAMARIE MINTURN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/25/24) ANNAMARIE MINTURN
Provider: Pepper, Robert Thomas MD
07/25/2024 PRO FEE/CLINIC $351.52
07/25/2024 Patient payment -$30.00
Patient Balance -$30.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$351.52
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$30.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878837} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629147
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354762 Upon Receipt $0.00 $
Page 1 of 1
DFTAATDFDATDTTFFDFAFAFAAFTDDADFTFDTFDTDTFATTAAAFDFFFTATFFTDDFFFAA FFTTDAATFFFAAFADATDAFFFTTADFDTTTDDDDATTDFATTTTTFTDDDDTTTTFFFADFTA
FRED I JOHNSON MORGAN MEDICAL CENTER
527 VILLAGE RD PO BOX 860
MADISON GA 30650-1764 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354762 FRED I JOHNSON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/15/24) FRED I JOHNSON
Provider: Pepper, Robert Thomas MD
07/15/2024 CLINIC $249.00
07/15/2024 DRUGS/DETAIL CODE $3.00
07/15/2024 PRO FEE/CLINIC $176.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$428.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878857} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8191865851
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354760 Upon Receipt $2,473.31 $
Page 1 of 1
TFAFFFDTAFFFTAAAFTTFDDFFFFAFAAATATTTTFAFFATDDDDDFAFDDDATDADFDADDF DDFDTDFFDFADFFTATAFFDAADFAFTAAFTFATAFDTFDAFFDFDTADATDTDDADAFFTTAT
BARBARA BUCHANAN MORGAN MEDICAL CENTER
460 HIGHWAY 142 LOT 4A PO BOX 860
COVINGTON GA 30014-8897 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354760 BARBARA BUCHANAN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/04/24) BARBARA BUCHANAN
Provider: Lawrence III, James MD
08/04/2024 NON-STER SUPPLY $31.48
08/04/2024 STERILE SUPPLY $26.92
08/04/2024 LABORATORY $146.00
08/04/2024 LAB/CHEMISTRY $357.00
08/04/2024 LAB/IMMUNOLOGY $17.00
08/04/2024 LAB/HEMATOLOGY $64.00
08/04/2024 CT SCAN/BODY $1,288.00
08/04/2024 EMERG ROOM $2,658.00
08/04/2024 DRUGS/DETAIL CODE $78.22
08/07/2024 Contractual Allowance Adjustment -$2,193.31
Patient Balance $2,473.31
MESSAGES
Thank you for choosing our facility as your healthcare provider.??The remaining
balance is your responsibility. If you have insurance, please contact our office at Total Charges: .....................................$4,666.62
1-888-618-1683. Insurance Payments/Adjustments:..............$0.00
Patient Payments/Adjustments: ..........-$2,193.31
PENDING BALANCE: $2,473.31
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878874} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7889415148
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354759 Upon Receipt $0.00 $
Page 1 of 1
DATDATTDDDDDFAADFTTAAATDAFADFDAAFFDDAAADAATTAFFFAATDFFFDFTTDDFFFF DTAAAFDDTADDTDDADDDDTTDDADFFAFDATAAFDTFATDDDDFADFFFAAFDAFDTDFATDD
CARLA A KELLY MORGAN MEDICAL CENTER
1071 PINTAIL LN PO BOX 860
MADISON GA 30650-3248 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354759 CARLA A KELLY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/23/24) CARLA A KELLY
Provider: SOLOMON, ALFRED TAWIAH
07/23/2024 LABORATORY $146.00
07/23/2024 LAB/CHEMISTRY $329.00
07/23/2024 LAB/HEMATOLOGY $64.00
07/23/2024 LAB/UROLOGY $6.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$545.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878886} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8132153398
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354757 Upon Receipt $0.00 $
Page 1 of 1
TDDTAFFAFTAAAFTTDAFDDTTDAAADAADDATDFFTADFDATDAADDDTDFDTTAAAFTTFFD FADFFTTAAATADDFDFFFTADTTDDDTDDAAADFTTDFTADTATTFFDFTFAFTFDADDAFDFF
BRENDA A CHILDS MORGAN MEDICAL CENTER
6607 SEVEN ISLANDS RD PO BOX 860
MADISON GA 30650-5328 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354757 BRENDA A CHILDS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/24/24) BRENDA A CHILDS
Provider: Spencer, Dennis DO
07/24/2024 DX X-RAY $441.00
07/24/2024 EMERG ROOM $1,906.00
07/24/2024 Patient payment -$50.00
Patient Balance -$50.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$2,347.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$50.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878903} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7952568505
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354756 Upon Receipt $0.00 $
Page 1 of 1
AAFTTTADDTADDFFDFDAFFATTTTDTDTDTTDTFFFDADDDTAFTAFAFFAFAFTTATTFAAD TAFDFTDFFTTTFADDTFADFDTFFFTTADAFFFATFFFFTTTFADFFAAATDFADFDFTDFTAF
MARY J ARMOUR MORGAN MEDICAL CENTER
1451 OCONEE AVE PO BOX 860
GREENSBORO GA 30642-2716 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354756 MARY J ARMOUR 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/31/24) MARY J ARMOUR
Provider: Cossio, Miguel Eduardo MD
07/31/2024 SCRN MAMMOGRAPHY $298.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$298.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878921} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7995793148
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354755 Upon Receipt $0.00 $
Page 1 of 1
DFATFAATDAFTFATFAATFATDTFAAAADFDFFTADDFDFDFTTDAFDDTTDDADAADADDDDF ATTTAFTTDTDFAAFAADTTDTDATFAFDFDFDTFFAAFDATFTFAATTADDFFFTDFATTADTD
DOROTHY R GEORGE MORGAN MEDICAL CENTER
1500 PIERCE DAIRY RD PO BOX 860
MADISON GA 30650-4960 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354755 DOROTHY R GEORGE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/13/24) DOROTHY R GEORGE
Provider: Chhabra, Anil Kumar MD
07/13/2024 NON-STER SUPPLY $31.48
07/13/2024 STERILE SUPPLY $26.92
07/13/2024 LABORATORY $146.00
07/13/2024 LAB/HEMATOLOGY $64.00
07/13/2024 DX X-RAY $396.00
07/13/2024 EMERG ROOM $3,131.00
07/13/2024 DRUGS/DETAIL CODE $68.02
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$3,863.42
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878932} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8174073045
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354754 Upon Receipt $0.00 $
Page 1 of 1
ADTDAFDFFDDFDDDTTDFTTFAFDAADFFDTFTTDATAATTADDDFTAADFDAFFDADAAAAAF ADDFTDAATDAFDTAAFAAATAAADTATDAFDATDATFTTFFDAFADTDTTFATFFTFTATTDFT
KEITH M FERGUSON MORGAN MEDICAL CENTER
1395 MORGAN DR PO BOX 860
BUCKHEAD GA 30625-2218 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354754 KEITH M FERGUSON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/22/24) KEITH M FERGUSON
Provider: BOULWARE, RONALD
07/22/2024 LABORATORY $245.50
07/22/2024 LAB/CHEMISTRY $323.00
07/22/2024 LAB/HEMATOLOGY $64.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$632.50
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878946} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7893015424
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354752 Upon Receipt $0.00 $
Page 1 of 1
DFTFTTTDATTADADDADAFFAAADDDADDDTTFDDATTTFTAAATDAAADFTADFDDDFTDADA TFAADAFDADFTTTTDDTTFAFFFATTFATTDTFTDDATADFADADTFFTFATTAAADDADDTDA
LORENZE O TREMONTI MORGAN MEDICAL CENTER
1250 FOUR LAKES DR PO BOX 860
MADISON GA 30650-4264 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354752 LORENZE O TREMONTI 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/15/24) LORENZE O TREMONTI
Provider: Pepper, Robert Thomas MD
07/15/2024 PRO FEE/OUTPT $306.15
07/15/2024 Patient payment -$25.00
Patient Balance -$25.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$25.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878963} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629553
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354750 Upon Receipt $0.00 $
Page 1 of 3
DDTAAFTTAFDTDFDTADATTTTATFTTFFADATAFATFTFFTADATTFADDFDFAFDADAFAAA DFAFATFDTAADTDDFDTFDAADDFTFAADFTTFAADTDADDFFTFFFFDAAADDFATTDFDTFD
MARK E PRICE MORGAN MEDICAL CENTER
268 SPRING RD PO BOX 860
COVINGTON GA 30016-1778 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354750 MARK E PRICE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/18/24 - 07/09/24) MARK E PRICE
Provider: Beharrysingh, Rudra MD
06/18/2024 MED-SUR-GY/PVT $1,654.00
06/18/2024 PHARMACY $41.17
06/18/2024 LABORATORY $146.00
06/18/2024 LAB/HEMATOLOGY $64.00
06/19/2024 MED-SUR-GY/PVT $1,654.00
06/19/2024 PHARMACY $312.80
06/19/2024 LAB/CHEMISTRY $87.00
06/19/2024 LAB/IMMUNOLOGY $17.00
06/19/2024 LAB/HEMATOLOGY $64.00
06/19/2024 PHYS THERP/EVAL $190.00
06/19/2024 OCCUPATION THER $77.00
06/19/2024 OCCUP THERP/EVAL $203.00
06/20/2024 MED-SUR-GY/PVT $1,654.00
06/20/2024 PHARMACY $417.88
06/20/2024 LABORATORY $282.00
06/20/2024 CT SCAN/BODY $1,288.00
06/20/2024 INHALATION SVC $507.00
06/20/2024 PHYSICAL THERAPY $292.00
06/20/2024 OCCUPATION THER $210.00
06/21/2024 MED-SUR-GY/PVT $1,654.00
06/21/2024 PHARMACY $664.04
06/21/2024 NON-STER SUPPLY $56.48
06/21/2024 STERILE SUPPLY $46.08
06/21/2024 LAB/HEMATOLOGY $64.00
06/21/2024 PHYSICAL THERAPY $319.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$53,420.53
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ...-$53,216.53
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878963}
Page 2 of 3
STATEMENT NUMBER STATEMENT DATE
300354750 08/07/2024
DUE DATE AMOUNT DUE
PATIENT STATEMENT Upon Receipt $0.00
For billing questions, please call: ACCOUNT NAME
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm MARK E PRICE
Payments/ Patient
Date Service Description Charges
Adjustments Balance
06/21/2024 OCCUPATION THER $61.00
06/22/2024 MED-SUR-GY/PVT $1,654.00
06/22/2024 PHARMACY $652.04
06/22/2024 NON-STER SUPPLY $10.00
06/22/2024 PHYSICAL THERAPY $55.00
06/23/2024 MED-SUR-GY/PVT $1,654.00
06/23/2024 PHARMACY $664.04
06/23/2024 STERILE SUPPLY $55.12
06/23/2024 PULMONARY FUNC $190.00
06/24/2024 MED-SUR-GY/PVT $1,654.00
06/24/2024 PHARMACY $533.80
06/24/2024 STERILE SUPPLY $19.16
06/24/2024 LABORATORY $146.00
06/24/2024 LAB/HEMATOLOGY $64.00
06/25/2024 MED-SUR-GY/PVT $1,654.00
06/25/2024 PHARMACY $312.80
06/25/2024 STERILE SUPPLY $19.16
06/25/2024 PHYSICAL THERAPY $286.00
06/25/2024 OCCUPATION THER $176.00
06/25/2024 PULMONARY FUNC $190.00
06/26/2024 MED-SUR-GY/PVT $1,654.00
06/26/2024 PHARMACY $276.80
06/26/2024 STERILE SUPPLY $8.00
06/26/2024 PHYSICAL THERAPY $286.00
06/26/2024 PULMONARY FUNC $190.00
06/27/2024 MED-SUR-GY/PVT $1,654.00
06/27/2024 PHARMACY $336.80
06/27/2024 NON-STER SUPPLY $5.00
06/27/2024 PHYSICAL THERAPY $286.00
06/27/2024 OCCUPATION THER $122.00
06/27/2024 PULMONARY FUNC $190.00
06/28/2024 MED-SUR-GY/PVT $1,654.00
06/28/2024 PHARMACY $324.80
06/28/2024 NON-STER SUPPLY $5.00
06/28/2024 STERILE SUPPLY $35.28
06/28/2024 PHYSICAL THERAPY $286.00
06/28/2024 OCCUPATION THER $210.00
06/28/2024 PULMONARY FUNC $190.00
06/29/2024 MED-SUR-GY/PVT $1,654.00
06/29/2024 PHARMACY $300.80
06/29/2024 NON-STER SUPPLY $10.00
06/29/2024 STERILE SUPPLY $5.00
06/30/2024 MED-SUR-GY/PVT $1,654.00
06/30/2024 PHARMACY $312.80
06/30/2024 PULMONARY FUNC $190.00
07/01/2024 MED-SUR-GY/PVT $1,654.00
07/01/2024 PHARMACY $336.80
07/01/2024 LABORATORY $146.00
07/01/2024 LAB/HEMATOLOGY $64.00
07/01/2024 INHALATION SVC $507.00
07/01/2024 PHYSICAL THERAPY $286.00
07/01/2024 OCCUPATION THER $149.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
APD{3120878963}
Page 3 of 3
STATEMENT NUMBER STATEMENT DATE
300354750 08/07/2024
DUE DATE AMOUNT DUE
PATIENT STATEMENT Upon Receipt $0.00
For billing questions, please call: ACCOUNT NAME
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm MARK E PRICE
Payments/ Patient
Date Service Description Charges
Adjustments Balance
07/02/2024 MED-SUR-GY/PVT $1,654.00
07/02/2024 PHARMACY $264.80
07/02/2024 PHYSICAL THERAPY $286.00
07/02/2024 PULMONARY FUNC $190.00
07/03/2024 MED-SUR-GY/PVT $1,654.00
07/03/2024 PHARMACY $252.80
07/03/2024 NON-STER SUPPLY $5.00
07/03/2024 STERILE SUPPLY $32.28
07/03/2024 PHYSICAL THERAPY $231.00
07/03/2024 OCCUPATION THER $122.00
07/03/2024 PULMONARY FUNC $190.00
07/04/2024 MED-SUR-GY/PVT $1,654.00
07/04/2024 PHARMACY $300.80
07/04/2024 PHYSICAL THERAPY $286.00
07/05/2024 MED-SUR-GY/PVT $1,654.00
07/05/2024 PHARMACY $312.80
07/05/2024 STERILE SUPPLY $71.24
07/05/2024 PHYSICAL THERAPY $286.00
07/05/2024 OCCUPATION THER $122.00
07/06/2024 MED-SUR-GY/PVT $1,654.00
07/06/2024 PHARMACY $312.80
07/07/2024 MED-SUR-GY/PVT $1,654.00
07/07/2024 PHARMACY $300.80
07/07/2024 PULMONARY FUNC $190.00
07/08/2024 MED-SUR-GY/PVT $1,654.00
07/08/2024 PHARMACY $324.80
07/08/2024 NON-STER SUPPLY $15.00
07/08/2024 STERILE SUPPLY $10.00
07/08/2024 LABORATORY $146.00
07/08/2024 LAB/HEMATOLOGY $64.00
07/08/2024 PHYSICAL THERAPY $286.00
07/09/2024 PHARMACY $242.76
07/29/2024 Medicare payment -$66,816.17
07/29/2024 Contractual Allowance Adjustment $13,599.64
Patient Balance $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
APD{3120878976} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629551
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354745 Upon Receipt $0.00 $
Page 1 of 2
TTDAAFTFFDTATFATAAATTAAADFFADAAAAATFTTFTAAFAFDADFADADFTFFAAFDAFDA FDDAFFAAAAFADDFTFADTTFTTTTDDDFTTATFDTTDTFDATDTADDDDFADTATADDATDDF
RUTH R AYCOX MORGAN MEDICAL CENTER
3190 APALACHEE RD PO BOX 860
MADISON GA 30650-2817 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354745 RUTH R AYCOX 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/31/24 - 08/03/24) RUTH R AYCOX
Provider: Beharrysingh, Rudra MD
07/31/2024 PHARMACY $60.00
07/31/2024 IV SOLUTIONS $30.06
07/31/2024 STERILE SUPPLY $43.16
07/31/2024 LABORATORY $146.00
07/31/2024 LAB/CHEMISTRY $393.00
07/31/2024 LAB/IMMUNOLOGY $17.00
07/31/2024 LAB/HEMATOLOGY $64.00
07/31/2024 LAB/BACT-MICRO $46.00
07/31/2024 LAB/UROLOGY $36.00
07/31/2024 EMERG ROOM $3,028.00
07/31/2024 DRUGS/DETAIL CODE $193.38
07/31/2024 OBSERVATION RM $920.00
08/01/2024 PHARMACY $157.92
08/01/2024 STERILE SUPPLY $115.16
08/01/2024 LAB/CHEMISTRY $87.00
08/01/2024 LAB/HEMATOLOGY $64.00
08/01/2024 ULTRASOUND $337.00
08/01/2024 DRUGS/DETAIL CODE $298.72
08/01/2024 OBSERVATION RM $1,379.00
08/02/2024 PHARMACY $97.92
08/02/2024 STERILE SUPPLY $96.00
08/02/2024 LAB/CHEMISTRY $19.00
08/02/2024 LAB/HEMATOLOGY $64.00
08/02/2024 DRUGS/DETAIL CODE $230.70
08/02/2024 OBSERVATION RM $1,379.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$10,946.44
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120878976}
Page 2 of 2
STATEMENT NUMBER STATEMENT DATE
300354745 08/07/2024
DUE DATE AMOUNT DUE
PATIENT STATEMENT Upon Receipt $0.00
For billing questions, please call: ACCOUNT NAME
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm RUTH R AYCOX
Payments/ Patient
Date Service Description Charges
Adjustments Balance
08/03/2024 PHARMACY $97.92
08/03/2024 STERILE SUPPLY $67.16
08/03/2024 LAB/CHEMISTRY $19.00
08/03/2024 DRUGS/DETAIL CODE $81.34
08/03/2024 OBSERVATION RM $1,379.00
Patient Balance $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
APD{3120878990} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8141298088
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354743 Upon Receipt $0.00 $
Page 1 of 1
FAATTADTFFDFTTAFFADTFATDAFFFTTFFTDFADAATAFFDTFFAFAAAFAAADAADTFATD FTTDDDTTFFTAAFATADFADDFTDFDADAAADTDTADADAATADTDTTFTDFATDDAFFAAFAA
CHARLES LEEPER MORGAN MEDICAL CENTER
1310 PRICE MILL RD PO BOX 860
MADISON GA 30650-2866 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354743 CHARLES LEEPER 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/13/24) CHARLES LEEPER
Provider: Chhabra, Anil Kumar MD
06/13/2024 IV SOLUTIONS $142.10
06/13/2024 NON-STER SUPPLY $31.48
06/13/2024 STERILE SUPPLY $40.92
06/13/2024 LABORATORY $146.00
06/13/2024 LAB/HEMATOLOGY $164.00
06/13/2024 LAB/OTHER $196.00
06/13/2024 EMERG ROOM $3,188.00
06/13/2024 DRUGS/DETAIL CODE $263.43
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$4,171.93
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879007} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8059154609
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354741 Upon Receipt $0.00 $
Page 1 of 1
FFAFFTTDTADTFAFFFDTAFDTTDFDFTTATTFADDFFDADTDTDFATFDDFFDTFDATDFTTF DAFTTADFDFDDFFTFTFDFFTADAFFDATDAFFTFFTAFTAFDTFTFAFFTDADTFTAFFFATT
FAYE E CATHCART MORGAN MEDICAL CENTER
1350 SEVEN ISLANDS RD PO BOX 860
BUCKHEAD GA 30625-1318 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354741 FAYE E CATHCART 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/01/24) FAYE E CATHCART
Provider: Gallo, Martin Robert MD
08/01/2024 PRO FEE/CLINIC $685.52
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$685.52
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879021} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8191865855
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354738 Upon Receipt $0.00 $
Page 1 of 1
FDFTDFAATFFDADTADDFTFDDATAATDDFDFFDFTDAATFAAADDAATDAAFFADFTTTFDTD AADATATATDDFDTAFFFTAATAATDADDTDFADDFTAATAFFTAATADADFAAFADFTATFDDT
SHERRY L CHANDLER MORGAN MEDICAL CENTER
768 S STEEL BRIDGE RD PO BOX 860
EATONTON GA 31024-8133 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354738 SHERRY L CHANDLER 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/13/24) SHERRY L CHANDLER
Provider: Pepper, Robert Thomas MD
06/13/2024 CLINIC $130.00
06/13/2024 PRO FEE/CLINIC $176.15
06/27/2024 Medicare payment -$123.29
06/27/2024 Contractual Allowance Adjustment -$151.40
Patient Balance $31.46
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ........-$274.69
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879038} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7908316597
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354735 Upon Receipt $0.00 $
Page 1 of 1
AADTTTDATTDTDDDDFFFAADATDDTDTDFAAFADADAATTFATDAADFTAFFAFFADAFFDDA TTAFDDDDADTTTTTTDDAFTDFFFDTAAAAFTATTDFAATFTFFDDDFAAATAAFFDDADATFA
MAUREUS A WILLIAMS MORGAN MEDICAL CENTER
PO BOX 330 PO BOX 860
MADISON GA 30650-0330 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354735 MAUREUS A WILLIAMS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/10/24) MAUREUS A WILLIAMS
Provider: Werkin, Jacob MD
07/10/2024 PRO FEE/OUTPT $306.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879052} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7916617140
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354733 Upon Receipt $0.00 $
Page 1 of 1
DDDADATFAFTDTADATDDAFFTFAFAFFFDDFTAFTDAFTDAAADAFAFTTDADDFTFAFDATF TDFTFFFFFTFTFADTTATDDFTFAATDAFTDFAADFADFDTADFDATATFTDDATADFTDTATF
CORLISA D JEFFERSON MORGAN MEDICAL CENTER
390 CEMETERY ST PO BOX 860
SHADY DALE GA 31085-3584 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354733 CORLISA D JEFFERSON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/02/24) CORLISA D JEFFERSON
Provider: Rafeedie, George Kaleel MD
08/02/2024 DRUGS/INCIDENT RAD $500.00
08/02/2024 LABORATORY $146.00
08/02/2024 LAB/CHEMISTRY $120.00
08/02/2024 LAB/HEMATOLOGY $64.00
08/02/2024 LAB/UROLOGY $6.00
08/02/2024 CT SCAN/BODY $1,381.00
08/02/2024 EMERG ROOM $2,659.00
08/02/2024 DRUGS/DETAIL CODE $44.02
08/02/2024 Patient payment -$25.00
Patient Balance -$25.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$4,920.02
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$25.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879067} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8132856803
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354730 Upon Receipt $0.00 $
Page 1 of 1
DTDTFTFFAFFTADDDDATDADTAAAFTFTDTFFFFAFDTFFAAATDATTFFDFTAADFFDFADA AFTDATATDTAFAAFFATATFADADAAADDFDDDFAAFDDFTFAAAFATTTDDDFDTAATTDFAD
SHELIA E DYSART MORGAN MEDICAL CENTER
140 BELMONT TRL PO BOX 860
COVINGTON GA 30016-5090 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354730 SHELIA E DYSART 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/30/24) SHELIA E DYSART
Provider: Fletcher, David Troy MD
07/30/2024 SCRN MAMMOGRAPHY $298.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$298.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879089} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7894115500
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354729 Upon Receipt $0.00 $
Page 1 of 1
TDTFDDTATTTAADDADDTTTFFATDDDDAFDTATFTTTDFAAADDATDFATAAFTDTFFATFDA AATFFTTTATTATTFDFDATADDADDTADDAFTDFTTFFTADAAATFADATFTFAFDFDTTFDFF
THOMAS CHRISTOPHER BONE MORGAN MEDICAL CENTER
1220 KNIGHT RD PO BOX 860
MADISON GA 30650-4483 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354729 THOMAS CHRISTOPHER BONE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/02/24) THOMAS C BONE
Provider: VORA, RAVI SIDDHARTH
08/02/2024 LABORATORY $292.00
08/02/2024 LAB/CHEMISTRY $198.00
08/02/2024 LAB/HEMATOLOGY $102.00
08/02/2024 LAB/BACT-MICRO $464.00
08/02/2024 Patient payment -$56.91
Patient Balance -$56.91
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,056.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$56.91
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879116} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8003727615
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354727 Upon Receipt $0.00 $
Page 1 of 1
TFTDTAFDAFFDDADDATTAFAAFAADAADFDFDDFTATTDFTDTTAFDDAFTDTAAAFDFDADT TTFAAFDFTTDDDTDADFTDTTTFADADAFDFAAAFDAFATDDDFFADFAFATFFAFDTTDAADD
NED L JORDAN MORGAN MEDICAL CENTER
774 PEARL ST PO BOX 860
MADISON GA 30650-1028 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354727 NED L JORDAN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/26/24) NED L JORDAN
Provider: Pepper, Robert Thomas MD
07/26/2024 ECHOCARDIOLOGY $1,197.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,197.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879141} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8060363061
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354725 Upon Receipt $0.00 $
Page 1 of 1
TDTDTTFADATAFDDFDAAAADTTFFADFTADFDADATATTDTTAADAFDTATFDATTATTDFAD TDADTDFDDDADAATATTAFDAFFFAAAAAFDDATAFFTFDAFFFFDDATATDTFDATAADTTAT
LISA A HILL MORGAN MEDICAL CENTER
119 CANE AVE SE PO BOX 860
SOCIAL CIRCLE GA 30025-4683 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354725 LISA A HILL 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/21/24) LISA A HILL
Provider: Cannington, Sara Danielle FNP
06/21/2024 PRO FEE/OUTPT $306.15
06/21/2024 Patient payment -$40.00
Patient Balance -$40.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$40.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879167} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7876713974
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354721 Upon Receipt $0.00 $
Page 1 of 1
TAAADTDFFFTDFDDDADDDFDFFTDAAFDDAAFDFTDFFTDDDAATFAFTDTAATDDFTFFDAA AFDTDAAAFDFAFAADAATAFFAATATDDTTDDDDDAFTDFAATATTFTTDDFTATTAFATDDTA
ASHLEY M CLARK MORGAN MEDICAL CENTER
1200 WHEAT ST APT 303 PO BOX 860
MADISON GA 30650-1162 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354721 ASHLEY M CLARK 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/25/24) ASHLEY M CLARK
Provider: Chhabra, Anil Kumar MD
07/25/2024 PHARMACY $24.00
07/25/2024 LABORATORY $133.00
07/25/2024 LAB/IMMUNOLOGY $85.00
07/25/2024 LAB/BACT-MICRO $86.00
07/25/2024 EMERG ROOM $2,131.00
07/25/2024 DRUGS/DETAIL CODE $364.14
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$2,823.14
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879182} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629236
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354716 Upon Receipt $0.00 $
Page 1 of 1
FTAFFDDDFFDATDDDDDTDDDAATTAFAAAFTDFFDDFAFAAFDFAADFFFAFTDDTDFFFATF DFFADAFFAFFTDDTDDADFAFADATDDATTTTFTDDDTADFADTDTFFDFATTTAADDFFDTDA
RASHAD KHAWAJA MORGAN MEDICAL CENTER
1101 WHITE PETAL CV PO BOX 860
MCDONOUGH GA 30253-8087 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354716 RASHAD KHAWAJA 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/29/24) RASHAD KHAWAJA
Provider: Werkin, Jacob MD
07/29/2024 PHARMACY $48.00
07/29/2024 MED-SUR SUPPLIES $41.84
07/29/2024 NON-STER SUPPLY $31.48
07/29/2024 STERILE SUPPLY $8,915.50
07/29/2024 DX X-RAY $500.00
07/29/2024 DX X-RAY/CHEST $171.00
07/29/2024 OR SERVICES $9,868.00
07/29/2024 ANESTHESIA $3,172.62
07/29/2024 DRUGS/DETAIL CODE $273.31
07/29/2024 RECOVERY ROOM $1,194.00
07/29/2024 EKG/ECG $154.00
07/29/2024 PRO FEE/ANES CRNA $1,467.00
07/29/2024 PRO FEE/OR $883.35
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$26,720.10
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879195} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7972817727
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354714 Upon Receipt $0.00 $
Page 1 of 1
FTTTDFFTFAFAATDTDDDADFFDDAADAFADDAFDAFTFDFADDTFDDFTDDAADTTFDTAADD FDTFTDATTFAFTDAAFTFATAFTDTFADAFTATDATTTTFFDADADTDDTFATDFTFTFATDFT
CHINNADA R ARMOUR MORGAN MEDICAL CENTER
11 FOX CHASE CIR APT 8 PO BOX 860
GREENSBORO GA 30642-2939 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354714 CHINNADA R ARMOUR 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/26/24) CHINNADA R ARMOUR
Provider: Cannington, Sara Danielle FNP
06/26/2024 LABORATORY $203.00
06/26/2024 LAB/CHEMISTRY $205.00
06/26/2024 LAB/HEMATOLOGY $64.00
06/26/2024 CLINIC $130.00
06/26/2024 PRO FEE/CLINIC $338.83
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$940.83
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879207} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629011
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354709 Upon Receipt $0.00 $
Page 1 of 1
AFDDDATATATTDDTDTDAFFADAFDAAFTTTADDFAADTFFFDADFADAFATAFFFTADFDFTD FTDTAFTADADFFFFAAFDTDTTTTFFDDFDADTFFADFDATFTDAATTFDDFFDTDFADAADTD
MARY W DILETTO MORGAN MEDICAL CENTER
1665 FOUR LAKES DR PO BOX 860
MADISON GA 30650-4274 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354709 MARY W DILETTO 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/02/24) MARY W DILETTO
Provider: Ashford, William MD
07/02/2024 PHARMACY $121.39
07/02/2024 MED-SUR SUPPLIES $41.84
07/02/2024 NON-STER SUPPLY $31.48
07/02/2024 STERILE SUPPLY $1,569.78
07/02/2024 SUPPLY/IMPLANTS $8,937.00
07/02/2024 OR SERVICES $9,649.00
07/02/2024 ANESTHESIA $4,518.58
07/02/2024 DRUGS/DETAIL CODE $334.46
07/02/2024 RECOVERY ROOM $1,194.00
07/02/2024 PRO FEE/ANES CRNA $2,303.00
07/30/2024 Medicare payment -$8,984.18
07/30/2024 Contractual Allowance Adjustment -$13,934.57
08/06/2024 Contractual Allowance Adjustment -$52.08
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$28,700.53
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ...-$22,970.83
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879221} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7953770530
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354705 Upon Receipt $0.00 $
Page 1 of 1
AAFAFAFAFDFDAFFDTATTFDTDTTDFFTFFADFDAFFFTAFTADTADDTDTDDTTFAFAFDDA DAADFTDDFATTAFDDTDFDFDDDFFDAADAAFFATFTFFTTTFTDFFAFATDFTDFDFDFFTAF
CALVIN L WELCH MORGAN MEDICAL CENTER
1300 MORRIS RD PO BOX 860
MADISON GA 30650-3936 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354705 CALVIN L WELCH 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/01/24 - 07/31/24) CALVIN L WELCH
Provider: WELSH, TIAYA
07/02/2024 PHYSICAL THERAPY $183.00
07/05/2024 PHYSICAL THERAPY $183.00
07/09/2024 PHYSICAL THERAPY $183.00
07/11/2024 PHYSICAL THERAPY $183.00
07/16/2024 PHYSICAL THERAPY $183.00
07/19/2024 PHYSICAL THERAPY $183.00
07/23/2024 PHYSICAL THERAPY $183.00
07/26/2024 PHYSICAL THERAPY $244.00
07/31/2024 PHYSICAL THERAPY $183.00
07/11/2024 Patient payment -$40.00
07/19/2024 Patient payment -$20.00
07/26/2024 Patient payment -$20.00
08/02/2024 Patient payment -$10.00
Patient Balance -$90.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,708.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$90.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879231} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7994389468
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354703 Upon Receipt $0.00 $
Page 1 of 1
FFTDTTAATTFATDFFFFTDATTTDTTDFDTTDDDTFTTADTADTAFAFTFFADAFTFTDFDTFD TAATTADDDDDDAATFTDTFFTFFAFAFATDFFFTFFAAFTADDAFTFAAFTFAFTFTAADFTTT
ANDREA N WILSON MORGAN MEDICAL CENTER
3291 FAIRPLAY RD PO BOX 860
MADISON GA 30650-2663 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354703 ANDREA N WILSON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/16/24) ANDREA N WILSON
Provider: Zant Jr, Walter Daniel MD
07/16/2024 SCRN MAMMOGRAPHY $298.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$298.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879246} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7969611422
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354698 Upon Receipt $0.00 $
Page 1 of 1
FDDATDDAAFDADFDADFFFDTFFADTTFFDTAATTTAAAATFADDTTFADFDFDADFAFAADFD ATDDDDTAFDTAFAATAFAADDAADFTTDAAFDTDTAFADAATAFTDDTATDFAADDFFATADAA
SARA M SIMMONS MORGAN MEDICAL CENTER
1350 APALACHEE WOODS TRL PO BOX 860
BUCKHEAD GA 30625-1503 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354698 SARA M SIMMONS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/04/24 - 06/30/24) SARA M SIMMONS
Provider: BACASTOW, DAVID W.
06/04/2024 PHYS THERP/EVAL $266.00
06/12/2024 PHYSICAL THERAPY $183.00
06/18/2024 PHYSICAL THERAPY $183.00
06/04/2024 Patient payment -$25.00
06/12/2024 Patient payment -$25.00
06/18/2024 Patient payment -$25.00
Patient Balance -$75.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$632.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$75.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879259} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8118275482
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354697 Upon Receipt $0.00 $
Page 1 of 3
DTFFFFDTATTTATAADDDTDATFTDFTTAAATTTTAADDATADFFFTDAATAFADDDTDDAFTD ADTAFFATATFATTFTFTTTTFDATTTFDFTDATFDTADTFDATFTATDTDFTDAATFDTTTDDF
EMORY GARY STEWART MORGAN MEDICAL CENTER
1170 SULGRAVE DR PO BOX 860
MADISON GA 30650-4614 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354697 EMORY GARY STEWART 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/01/24 - 06/30/24) EMORY G STEWART
Provider: VISITACION, MARK PAUL
06/01/2024 IV THERAPY $568.00
06/01/2024 STERILE SUPPLY $41.00
06/01/2024 CLINIC $130.00
06/01/2024 DRUGS/DETAIL CODE $600.00
06/02/2024 IV THERAPY $568.00
06/02/2024 STERILE SUPPLY $41.00
06/02/2024 CLINIC $130.00
06/02/2024 DRUGS/DETAIL CODE $600.00
06/03/2024 STERILE SUPPLY $56.56
06/03/2024 CLINIC $698.00
06/03/2024 DRUGS/DETAIL CODE $600.00
06/04/2024 STERILE SUPPLY $40.28
06/04/2024 CLINIC $698.00
06/04/2024 DRUGS/DETAIL CODE $600.00
06/05/2024 STERILE SUPPLY $116.16
06/05/2024 LABORATORY $151.00
06/05/2024 LAB/IMMUNOLOGY $17.00
06/05/2024 LAB/HEMATOLOGY $129.00
06/05/2024 CLINIC $948.00
06/05/2024 DRUGS/DETAIL CODE $600.00
06/08/2024 IV THERAPY $568.00
06/08/2024 STERILE SUPPLY $41.00
06/08/2024 CLINIC $130.00
06/08/2024 DRUGS/DETAIL CODE $600.00
06/09/2024 IV THERAPY $568.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$34,276.86
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879259}
Page 2 of 3
STATEMENT NUMBER STATEMENT DATE
300354697 08/07/2024
DUE DATE AMOUNT DUE
PATIENT STATEMENT Upon Receipt $0.00
For billing questions, please call: ACCOUNT NAME
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm EMORY GARY STEWART
Payments/ Patient
Date Service Description Charges
Adjustments Balance
06/09/2024 STERILE SUPPLY $41.00
06/09/2024 CLINIC $130.00
06/09/2024 DRUGS/DETAIL CODE $648.00
06/11/2024 STERILE SUPPLY $40.28
06/11/2024 CLINIC $698.00
06/11/2024 DRUGS/DETAIL CODE $600.00
06/12/2024 STERILE SUPPLY $84.16
06/12/2024 LABORATORY $151.00
06/12/2024 LAB/HEMATOLOGY $129.00
06/12/2024 CLINIC $948.00
06/12/2024 DRUGS/DETAIL CODE $600.00
06/13/2024 STERILE SUPPLY $40.28
06/13/2024 CLINIC $698.00
06/13/2024 DRUGS/DETAIL CODE $600.00
06/14/2024 STERILE SUPPLY $40.28
06/14/2024 CLINIC $698.00
06/14/2024 DRUGS/DETAIL CODE $600.00
06/15/2024 IV THERAPY $568.00
06/15/2024 STERILE SUPPLY $43.16
06/15/2024 CLINIC $130.00
06/15/2024 DRUGS/DETAIL CODE $600.00
06/16/2024 IV THERAPY $568.00
06/16/2024 STERILE SUPPLY $43.16
06/16/2024 CLINIC $130.00
06/16/2024 DRUGS/DETAIL CODE $600.00
06/17/2024 STERILE SUPPLY $40.28
06/17/2024 CLINIC $698.00
06/17/2024 DRUGS/DETAIL CODE $600.00
06/19/2024 LABORATORY $151.00
06/19/2024 LAB/HEMATOLOGY $129.00
06/20/2024 STERILE SUPPLY $40.28
06/20/2024 CLINIC $698.00
06/20/2024 DRUGS/DETAIL CODE $600.00
06/22/2024 IV THERAPY $568.00
06/22/2024 STERILE SUPPLY $43.16
06/22/2024 CLINIC $130.00
06/22/2024 DRUGS/DETAIL CODE $600.00
06/23/2024 IV THERAPY $568.00
06/23/2024 STERILE SUPPLY $43.16
06/23/2024 DRUGS/DETAIL CODE $600.00
06/24/2024 STERILE SUPPLY $40.28
06/24/2024 CLINIC $828.00
06/24/2024 DRUGS/DETAIL CODE $600.00
06/25/2024 STERILE SUPPLY $40.28
06/25/2024 CLINIC $698.00
06/25/2024 DRUGS/DETAIL CODE $600.00
06/26/2024 STERILE SUPPLY $84.16
06/26/2024 LABORATORY $151.00
06/26/2024 LAB/IMMUNOLOGY $17.00
06/26/2024 LAB/HEMATOLOGY $129.00
06/26/2024 CLINIC $948.00
06/26/2024 DRUGS/DETAIL CODE $600.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
APD{3120879259}
Page 3 of 3
STATEMENT NUMBER STATEMENT DATE
300354697 08/07/2024
DUE DATE AMOUNT DUE
PATIENT STATEMENT Upon Receipt $0.00
For billing questions, please call: ACCOUNT NAME
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm EMORY GARY STEWART
Payments/ Patient
Date Service Description Charges
Adjustments Balance
06/27/2024 STERILE SUPPLY $40.28
06/27/2024 CLINIC $698.00
06/27/2024 DRUGS/DETAIL CODE $600.00
06/28/2024 STERILE SUPPLY $40.28
06/28/2024 CLINIC $698.00
06/28/2024 DRUGS/DETAIL CODE $600.00
06/29/2024 IV THERAPY $568.00
06/29/2024 STERILE SUPPLY $43.16
06/29/2024 CLINIC $130.00
06/29/2024 DRUGS/DETAIL CODE $600.00
06/30/2024 IV SOLUTIONS $30.06
06/30/2024 IV THERAPY $568.00
06/30/2024 STERILE SUPPLY $19.16
06/30/2024 CLINIC $130.00
06/30/2024 DRUGS/DETAIL CODE $600.00
Patient Balance $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
APD{3120879270} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8190056811
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354696 Upon Receipt $0.00 $
Page 1 of 1
FADAATDADADDDFTFFTATATDAFFTDTTAFADFDTFFTAFDDTTAFDDFATDFFDTDADFFDD TFFFATFFTTADDTDFDAADAATFFTATADFDTFAADFDADDDFAFFFFTAATDFFADTTDDAFD
BRENTON ROBBINS MORGAN MEDICAL CENTER
420 W RICHLAND AVE PO BOX 860
GREENSBORO GA 30642-1032 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354696 BRENTON ROBBINS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (05/31/24) BRENTON ROBBINS
Provider: Spencer, Dennis DO
05/31/2024 IV SOLUTIONS $44.02
05/31/2024 NON-STER SUPPLY $31.48
05/31/2024 STERILE SUPPLY $7.76
05/31/2024 LABORATORY $207.25
05/31/2024 LAB/CHEMISTRY $228.00
05/31/2024 LAB/HEMATOLOGY $164.00
05/31/2024 DX X-RAY $147.00
05/31/2024 EMERG ROOM $1,943.00
05/31/2024 EKG/ECG $154.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$2,926.51
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879281} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8156981704
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354695 Upon Receipt $0.00 $
Page 1 of 1
AFAFTADATAFTADTFFDTTFTTAAATAFDTTDDFTDDFDATDTAFTDFAFFTFFFFDAADATDA FFDDATAADAAFFFFFAAFTFATTDAFTDDFTDDFAADDDFTDATAFATDTDFDDDTFADADFAD
MELISSA L NELSON MORGAN MEDICAL CENTER
516 MONTGOMERY HOMES PO BOX 860
EATONTON GA 31024-2005 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354695 MELISSA L NELSON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (04/25/24) MELISSA L NELSON
Provider: Cannington, Sara Danielle FNP
04/25/2024 PRO FEE/OUTPT $306.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879298} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8181918997
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354693 Upon Receipt $0.00 $
Page 1 of 1
TATFATDFAFTAFDTDTDDAAAATAFDTTDFAAFADATDDTTTFTTAFAAFTDAATFATTTFADT DDATFFFDFAFTAFDTTTDDDFDDAADFAFTTFAADFDDFDTTDDDATADFTDDTTATFDFTATF
JAMES S ROOKS MORGAN MEDICAL CENTER
1070 W MAGNOLIA LOOP PO BOX 860
MADISON GA 30650-5089 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354693 JAMES S ROOKS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/03/24) JAMES S ROOKS
Provider: Wingate III, Harry Lynnwood MD
06/03/2024 CT SCAN/HEAD $1,545.00
06/03/2024 EMERG ROOM $2,397.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$3,942.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879314} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629143
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354691 Upon Receipt $0.00 $
Page 1 of 1
DFFDDFDFFTDTFDAFAADDDAFAAFFDFTDFFDTFDAFTDFATDFFTTTAFTAAFTTDTTAAAD DTFFDDDFAFTTDDTTDFFFTDADFDDTAAAATATTDTAATFAFDDDDFFAAAATFFTDFFAAFA
KAREN NUNERY MORGAN MEDICAL CENTER
56 SANDPIPER CT PO BOX 860
MONTICELLO GA 31064-3432 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354691 KAREN NUNERY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/25/24) KAREN NUNERY
Provider: Chhabra, Anil Kumar MD
07/25/2024 LABORATORY $340.25
07/25/2024 LAB/CHEMISTRY $211.00
07/25/2024 LAB/HEMATOLOGY $64.00
07/25/2024 DX X-RAY/CHEST $171.00
07/25/2024 EMERG ROOM $1,943.00
07/25/2024 EKG/ECG $154.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$2,883.25
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879326} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629531
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354690 Upon Receipt $0.00 $
Page 1 of 1
DDATADTDFDDDDDDTDDFTTFDAFADTDFDTDTDAFDTAFDDTFTFDFAFADAFAFFDTFATTT FATATATTTFDFTDAFFDDAATFTTDFFDTDAADDFTDATAFDTTATADFDFAADADATFAFDDT
JENNIFER C PETERSEN MORGAN MEDICAL CENTER
148 E WASHINGTON ST UNIT 204 PO BOX 860
MADISON GA 30650-1265 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354690 JENNIFER C PETERSEN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (04/23/24) JENNIFER C PETERSEN
Provider: Chhabra, Anil Kumar MD
04/23/2024 PHARMACY $12.00
04/23/2024 LABORATORY $146.00
04/23/2024 LAB/CHEMISTRY $470.00
04/23/2024 LAB/HEMATOLOGY $164.00
04/23/2024 CT SCAN/HEAD $1,545.00
04/23/2024 EMERG ROOM $1,943.00
04/23/2024 EKG/ECG $154.00
06/03/2024 Commercial insurance payment -$2,660.40
06/03/2024 Contractual Allowance Adjustment -$1,108.50
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$4,434.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: .....-$3,768.90
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879338} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8186742342
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354689 Upon Receipt $0.00 $
Page 1 of 1
AFFAFTTFTATAFTDDTTADATADDFTAFDAFTFATDAADTFAAADAFATTTFTTDDATAADADA FTADTDDTDFTDTFAATDFADTFDDFFAFAFAFTTAADAAAADFDADDAFTADADFFAAFAATAT
SHIRLEY J DUNN MORGAN MEDICAL CENTER
1911 CAREY STATION RD PO BOX 860
GREENSBORO GA 30642-2681 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354689 SHIRLEY J DUNN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (11/22/23) SHIRLEY J DUNN
Provider: Cannington, Sara Danielle FNP
11/22/2023 CLINIC $130.00
11/22/2023 PRO FEE/OUTPT $176.15
12/21/2023 Medicare payment -$39.49
12/21/2023 Contractual Allowance Adjustment -$240.66
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ........-$280.15
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879348} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7863211509
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354688 Upon Receipt $0.00 $
Page 1 of 1
ATFFTDDTAAADDDAATAFFTTFTFADAAADTAAFFTFAAFAFAFDFTTDDDDFFAAAAATFDFF DADTDATFFFDADFTDADDFFDFTAFDFTTTAFFDDFDATTAATTDTATFFFDATADTFFFFDTA
BRITTANY D MAXEY MORGAN MEDICAL CENTER
1201 ELLIOTT RD PO BOX 860
MANSFIELD GA 30055-3406 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354688 BRITTANY D MAXEY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/25/24) DANIEL W STEPHENS
Provider: Spencer, Dennis DO
07/25/2024 PHARMACY $24.00
07/25/2024 STERILE SUPPLY $76.96
07/25/2024 EMERG ROOM $1,929.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$2,029.96
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879361} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7966194473
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354686 Upon Receipt $1,718.26 $
Page 1 of 1
ADDDFDTDDDTADFDFDFFDFFTTDDAAATAFATDDFTDDDFDFTTDDDTFDAFAATTAFTAATD DFTFFTADAAAAADDDFAFDAFTTFTDTTDATTFFTDTDDDDAATDFADDADADTDTDDDFDFFF
NICOLE M BENTON MORGAN MEDICAL CENTER
2632 AIKENTON RD PO BOX 860
MONTICELLO GA 31064-6177 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354686 NICOLE M BENTON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (05/06/24) EVAN BENTON
Provider: Spencer, Dennis DO
Patient Balance $1,718.26
MESSAGES
We have not received payment. Please pay the current balance by the due date
shown. For questions regarding your bill, please contact our Billing office at Total Charges: .....................................$3,242.00
1-888-618-1683. Insurance Payments/Adjustments:..............$0.00
Patient Payments/Adjustments: ..........-$1,523.74
PENDING BALANCE: $1,718.26
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879374} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8110033550
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354685 Upon Receipt $0.00 $
Page 1 of 1
TFAADFFTDADADFFTATFFDTAFTFDATFDDDTADDAAFAADDFDDTFDTTAAATTDDFTTADF FDFAAFFATAFDFDFADTDTTADDTTFFFFDTATAFTDDFFDDDDAATFDDTADDTAATDATTDD
DORIS A RALSTON MORGAN MEDICAL CENTER
25 COUNTRY WALK PO BOX 860
SOCIAL CIRCLE GA 30025-5102 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354685 DORIS A RALSTON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/24/24) DORIS A RALSTON
Provider: Cannington, Sara Danielle FNP
07/24/2024 PRO FEE/OUTPT $224.93
07/24/2024 Patient payment -$30.00
Patient Balance -$30.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$224.93
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$30.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879389} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629528
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354684 Upon Receipt $0.00 $
Page 1 of 1
TDDTTAAAATTTDFTAATAADTFDDDDATAAFFFAATTDFTDTTDADFAFFATATFDDTFTFDFA TDDTAFAFDTFFDADAATTDDADAAAAFTFDDFAFFFFDTDTDTFFATTTFFDDFATDATDTDTD
KATHY POWERS MORGAN MEDICAL CENTER
2280 GREENSBORO ROAD PO BOX 860
MADISON GA 30650 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354684 KATHY POWERS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (05/06/24) KATHY POWERS
Provider: Spencer, Dennis DO
05/06/2024 PHARMACY $24.00
05/06/2024 CT SCAN/BODY $1,224.00
05/06/2024 EMERG ROOM $1,943.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$3,191.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879404} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629527
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354683 Upon Receipt $0.00 $
Page 1 of 1
TDDTTDTFAFTTAAFTAFATTFDFDTFFDATDAADAFFDDFDTDDTATAAFTDAFDDAAFAAATT AFADFTFTFTATTAFDTAATFFTFDATTFDADDDATAADAFTAFATFFATTAFDAFAFFTTDTAF
JULIE G JENKINS MORGAN MEDICAL CENTER
800 CRAWFORD ST PO BOX 860
MADISON GA 30650-1909 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354683 JULIE G JENKINS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (05/08/24) JULIE G JENKINS
Provider: Socoloff, David Neal DO
05/08/2024 PHARMACY $24.00
05/08/2024 MED-SUR SUPPLIES $41.84
05/08/2024 NON-STER SUPPLY $31.48
05/08/2024 STERILE SUPPLY $24.04
05/08/2024 OR SERVICES $2,254.00
05/08/2024 ANESTHESIA $1,778.59
05/08/2024 DRUGS/DETAIL CODE $64.80
05/08/2024 RECOVERY ROOM $1,194.00
05/08/2024 PRO FEE/ANES CRNA $1,467.00
07/17/2024 Medicare payment -$2,426.98
07/17/2024 Contractual Allowance Adjustment -$3,351.79
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$6,879.75
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: .....-$5,778.77
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879418} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8165932691
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354680 Upon Receipt $0.00 $
Page 1 of 1
FDAADDTAAFTTTATTFDATTADAFTTFAFFTTTDDAATTFFTTDTTDDAFADATFFFDAAATFF AAFADADAADDTFTADDDTAADFFTDTFFTTFADTDTAAFAFADATTFFADTTAATFADATFTDA
KEISHIA D REID MORGAN MEDICAL CENTER
496 E JEFFERSON ST PO BOX 860
MADISON GA 30650-1722 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354680 KEISHIA D REID 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/14/24) KEISHIA D REID
Provider: Pepper, Robert Thomas MD
06/14/2024 LABORATORY $5.00
06/14/2024 LAB/CHEMISTRY $65.75
06/14/2024 PRO FEE/OUTPT $390.08
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$460.83
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879428} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7879614282
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354678 Upon Receipt $0.00 $
Page 1 of 1
TFAFATDTAFDTAADDFDTFFAFTADDAFTFTDDFATTTDDFDFAAFFDFDDAFDDDFFAFDDAF TTTFTDTDTDTFATTAFFAFTTAAFDATTAFFTADADFADTFDAFFDDDAADTAFDDDTADAFFT
ROGER A PERKINS MORGAN MEDICAL CENTER
1051 GUINN RD PO BOX 860
MADISON GA 30650-4356 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354678 ROGER A PERKINS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/24/24) ROGER A PERKINS
Provider: Pepper, Robert Thomas MD
07/24/2024 CLINIC $130.00
07/24/2024 PRO FEE/CLINIC $176.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879441} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8118275482
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354677 Upon Receipt $0.00 $
Page 1 of 1
AATFDATFAFTAFDDFFFTFFAFTADAAFDAFTFFTFDTFTATTTADAFFTDAATDFFTAAFTTT DTTAFFTDAADAADDTFFDDTDTTADDDTFTATAFDDDFDTDTTDDADDFFDAFTTDTDDFAFDF
EMORY GARY STEWART MORGAN MEDICAL CENTER
1170 SULGRAVE DR PO BOX 860
MADISON GA 30650-4614 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354677 EMORY GARY STEWART 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/10/24) EMORY G STEWART
Provider: Long, Leah LPN
07/10/2024 STERILE SUPPLY $84.16
07/10/2024 LABORATORY $151.00
07/10/2024 LAB/IMMUNOLOGY $17.00
07/10/2024 LAB/HEMATOLOGY $129.00
07/10/2024 CLINIC $698.00
07/10/2024 DRUGS/DETAIL CODE $600.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,679.16
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879456} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629323
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354672 Upon Receipt $0.00 $
Page 1 of 1
TTTTAADDATFTAFAFFDFTFFDFFTDADDAFFFDADADADDFTATAFDATADDDADADTFFTDA FAFFATDATATDFDFFDDFTATDDDDFAFDFAADAATTFFADFFTAFAFFTTTFDDFATDAFAFD
MARK GUNTER MORGAN MEDICAL CENTER
519 KNOX CHAPEL RD PO BOX 860
SOCIAL CIRCLE GA 30025-4605 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354672 MARK GUNTER 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/22/24) MARK GUNTER
Provider: Pepper, Robert Thomas MD
07/22/2024 PRO FEE/OUTPT $306.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879473} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7885214775
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354671 Upon Receipt $0.00 $
Page 1 of 1
DDDDDFFTTTATFDDTTFDDTTADATADAFTTFTFTDDDDFTFTDTADTTDTADDTAAFDATTAD FFATTAFTDFFDTFAFTADAFAADTAFDFTDTDDTFADTAFAFDTATAADDADTDAAFAFADATT
JEFFREY A FLORENCE MORGAN MEDICAL CENTER
1731 HESTER TOWN RD PO BOX 860
MADISON GA 30650-2734 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354671 JEFFREY A FLORENCE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/04/24) JEFFREY A FLORENCE
Provider: Spencer, Dennis DO
07/04/2024 PHARMACY $36.00
07/04/2024 DRUGS/INCIDENT RAD $500.00
07/04/2024 LABORATORY $146.00
07/04/2024 LAB/CHEMISTRY $357.00
07/04/2024 LAB/IMMUNOLOGY $17.00
07/04/2024 LAB/HEMATOLOGY $64.00
07/04/2024 CT SCAN/BODY $1,381.00
07/04/2024 EMERG ROOM $2,658.00
07/04/2024 DRUGS/DETAIL CODE $92.02
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$5,251.02
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879488} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8026486138
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354670 Upon Receipt $0.00 $
Page 1 of 1
DDTAAFDAAATDTFDTDFFDDFDFDFFDTAFTTATFAATTFTDDDTATDFDFAFTADAFTDTFAD DDDDDDAFFFAADFTTATFFDFFTFADATAATFADTFTTTDATADDDDTDAFDTTFTDFFFTDAA
SANDRA L BONE MORGAN MEDICAL CENTER
2300 ATHENS HWY PO BOX 860
MADISON GA 30650-3722 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354670 SANDRA L BONE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/25/24) SANDRA L BONE
Provider: THOMAS, DANIEL STEPHEN
07/25/2024 DX X-RAY $276.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$276.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879501} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8199612482
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354667 Upon Receipt $0.00 $
Page 1 of 1
TDTFAFTTFTDAFATADDDFDAATDTTFDFFTDATAFAFDTFDFFATDDFTTTFDTDDAAFAAFA ADFFDDFAADATFTATDTAATFFFDTTAFAADATTTTATFFFTFFTDDFTTTTTADAADATTAFA
JONES LEE STONE MORGAN MEDICAL CENTER
213 HICKORY PT PO BOX 860
BUCKHEAD GA 30625-2905 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354667 JONES LEE STONE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/03/24) JONES L STONE
Provider: Pepper, Robert Thomas MD
07/03/2024 DX X-RAY $276.00
07/03/2024 CLINIC $130.00
07/03/2024 PRO FEE/CLINIC $176.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$582.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879516} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8198295745
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354666 Upon Receipt $0.00 $
Page 1 of 1
AFFAATFADADDDDAFFAFDFADADADDFTAFTFFTDTDTTDTAAFTFFDAFFAFFADDFADTAD TFTATAADTDFFATTFFATFAAAAATADTTDDTFDFDFTDDFFTAFTFDTFDTTFTTTTADDFDT
TIFFANY SPIVEY MORGAN MEDICAL CENTER
1171 WARE MCLENDON RD PO BOX 860
TIGNALL GA 30668-2923 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354666 TIFFANY SPIVEY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/22/24) TIFFANY SPIVEY
Provider: Cannington, Sara Danielle FNP
07/22/2024 LABORATORY $151.00
07/22/2024 LAB/CHEMISTRY $266.00
07/22/2024 LAB/HEMATOLOGY $64.00
07/22/2024 PRO FEE/CLINIC $486.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$967.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879532} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8200917789
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354663 Upon Receipt $0.00 $
Page 1 of 1
TDTFAFDDDDTDAADTFDDDDFDTDATFFFADTTDADTTFFFAFDFFTFFATAFDDDFTFAADTT TADDATTFDTTFDADFADADFTDAFFAATDFFFFFAFAFTTTDAAFFATAAFFFFFDTATDFFAD
ABEL NICHOLS MORGAN MEDICAL CENTER
638 CARRIAGE LN PO BOX 860
MADISON GA 30650-1778 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354663 ABEL NICHOLS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/08/24) ABEL NICHOLS
Provider: Cannington, Sara Danielle FNP
07/08/2024 LABORATORY $82.00
07/08/2024 CLINIC $130.00
07/08/2024 PRO FEE/CLINIC $94.93
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.93
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879547} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8120183612
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354662 Upon Receipt $0.00 $
Page 1 of 1
FDATTFFTADATFTAAFDATDTDFATDFDATDTTAFTTDDFATTDFDTFTFTADTDTAFDTTAFT ATATFFDTFTDTTAFTTFTTDDTFTFTDFFTFDTADAFFAATADFTADAADAFFAAFAFTTATTF
OLIVIA DAVIS MORGAN MEDICAL CENTER
1421 PLANTATION RD PO BOX 860
MADISON GA 30650-3353 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354662 OLIVIA DAVIS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (03/19/24) OLIVIA DAVIS
Provider: Cannington, Sara Danielle FNP
03/19/2024 LABORATORY $151.00
03/19/2024 LAB/CHEMISTRY $177.00
03/19/2024 LAB/HEMATOLOGY $64.00
03/19/2024 PRO FEE/CLINIC $312.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$704.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879563} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8191162276
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354659 Upon Receipt $1,356.50 $
Page 1 of 1
DFAFFTTTTFDAAATDFTTTAATATFDDTTDDFDDDDFTDDFAFTTADTATATDAATDADDTTDT FDAADFFTAFFTTDATDADATFADTTDDFATTATTDTTTAFFTDDTTTFDDAATTAAFDFATADA
KRISTEN STATHAM MORGAN MEDICAL CENTER
107 1/2 POPLAR ST PO BOX 860
EATONTON GA 31024-6231 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354659 KRISTEN STATHAM 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (03/21/24) WYATT WARREN
Provider: Chhabra, Anil Kumar MD
Patient Balance $1,356.50
MESSAGES
We have not received payment. Please pay the current balance by the due date
shown. For questions regarding your bill, please contact our Billing office at Total Charges: .....................................$2,110.00
1-888-618-1683. Insurance Payments/Adjustments: ........-$753.50
Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $1,356.50
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879577} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8191162279
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354658 Upon Receipt $3,066.61 $
Page 1 of 1
FTTFADFATTADDAAAFTAFTDDAFTFADADFTAFFAFDTFDAADTTDFDDTDTAFDDDTFDDFF DFDFTTAFTFAFDDTFFTFFAAFTFTFATTFTTFDADDTTDFFATFDADDAFATDFTTTFFDDFT
BARBARA OWENS MORGAN MEDICAL CENTER
64 BENTON RD PO BOX 860
COVINGTON GA 30014-5880 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354658 BARBARA OWENS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (03/24/24) BARBARA OWENS
Provider: Urhuogo, Awharitefe MD
Patient Balance $3,066.61
MESSAGES
We have not received payment. Please pay the current balance by the due date
shown. For questions regarding your bill, please contact our Billing office at Total Charges: .....................................$5,380.02
1-888-618-1683. Insurance Payments/Adjustments:..............$0.00
Patient Payments/Adjustments: ..........-$2,313.41
PENDING BALANCE: $3,066.61
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879593} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8142716472
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354657 Upon Receipt $0.00 $
Page 1 of 2
FFFDTADTFTFTFTTDFFFTFFTFAFFAFDFAADFTTTDFTFDDAFFFAFFDFTATDTFDTDFFA DATTAATDDADFAFDFAFDDFTTTAFFDTDDAFFFFFTFDTTDTTFAFTFFDFFDTDTADFFFTD
JOHN WYNE ASTIN MORGAN MEDICAL CENTER
239 E ATLANTA HWY PO BOX 860
RUTLEDGE GA 30663-2564 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354657 JOHN WYNE ASTIN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/01/24 - 07/03/24) JOHN W ASTIN
Provider: Johnson, Jeffery Irwin MD
07/01/2024 PHARMACY $48.00
07/01/2024 NON-STER SUPPLY $31.48
07/01/2024 STERILE SUPPLY $7.76
07/01/2024 LABORATORY $207.25
07/01/2024 LAB/CHEMISTRY $340.00
07/01/2024 LAB/HEMATOLOGY $164.00
07/01/2024 DX X-RAY/CHEST $171.00
07/01/2024 EMERG ROOM $2,684.00
07/01/2024 DRUGS/DETAIL CODE $96.00
07/01/2024 DRUGS/SELF ADMIN $60.00
07/01/2024 EKG/ECG $154.00
07/01/2024 OBSERVATION RM $1,489.00
07/02/2024 PHARMACY $249.36
07/02/2024 STERILE SUPPLY $358.00
07/02/2024 LAB/CHEMISTRY $191.00
07/02/2024 LAB/HEMATOLOGY $38.00
07/02/2024 PHYS THERP/EVAL $190.00
07/02/2024 PULMONARY FUNC $190.00
07/02/2024 DRUGS/DETAIL CODE $96.00
07/02/2024 DRUGS/SELF ADMIN $96.00
07/02/2024 EKG/ECG $154.00
07/02/2024 OBSERVATION RM $1,489.00
07/03/2024 PHARMACY $72.00
07/03/2024 NON-STER SUPPLY $31.48
07/03/2024 LAB/CHEMISTRY $191.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$10,385.33
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879593}
Page 2 of 2
STATEMENT NUMBER STATEMENT DATE
300354657 08/07/2024
DUE DATE AMOUNT DUE
PATIENT STATEMENT Upon Receipt $0.00
For billing questions, please call: ACCOUNT NAME
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm JOHN WYNE ASTIN
Payments/ Patient
Date Service Description Charges
Adjustments Balance
07/03/2024 LAB/HEMATOLOGY $38.00
07/03/2024 DRUGS/DETAIL CODE $24.00
07/03/2024 DRUGS/SELF ADMIN $36.00
07/03/2024 OBSERVATION RM $1,489.00
Patient Balance $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
APD{3120879608} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7863211487
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354656 Upon Receipt $100.00 $
Page 1 of 1
TDDDDDAFFDFFFDDTDFTDDDFDTATFTAFDTAFDADTFDFATFDATDTDTTTFDATFAFTTAF FTFDFDDAFATTFFFTTDFTDDDDDFDAFFAADTATADFFATAFDTFTAFTTDFTDFAFDAAAAF
MARION L MORRIS MORGAN MEDICAL CENTER
2360 SANDY CREEK RD PO BOX 860
MADISON GA 30650-3226 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354656 MARION L MORRIS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (03/15/24) MARION L MORRIS
Provider: Spencer, Dennis DO
Patient Balance $100.00
MESSAGES
We have not received payment. Please pay the current balance by the due date
shown. For questions regarding your bill, please contact our Billing office at Total Charges: .....................................$3,970.90
1-888-618-1683. Insurance Payments/Adjustments: .....-$3,870.90
Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $100.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879620} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7905316364
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354653 Upon Receipt $1,564.80 $
Page 1 of 1
ATDATFFFFDAFFAAADTTFTTFDAFTFDAFFTAFFFDADTAATDFTTATATTDFDTTFADTADD TTDFFDTFATTADTDTFDADTDDAFDTATFAFTAFTDFFTTDTAFDFDDAAFAFAFDTDTDADFF
LARRY DONELL CARTER JR MORGAN MEDICAL CENTER
827 E WASHINGTON ST PO BOX 860
MADISON GA 30650-1962 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354653 LARRY DONELL CARTER JR 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (02/24/23) LARRY D CARTER
Provider: Chhabra, Anil Kumar MD
Patient Balance $1,564.80
MESSAGES
We have not received payment. Please pay the current balance by the due date
shown. For questions regarding your bill, please contact our Billing office at Total Charges: .....................................$3,075.65
1-888-618-1683. Insurance Payments/Adjustments: .....-$1,510.85
Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $1,564.80
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879633} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8071243009
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354652 Upon Receipt $0.00 $
Page 1 of 1
FAADDTTFDDTDDDDFFADAFFDAFFAAATTFADDDADATTDFAAFAADFTATADAFTTAFFTFT AAAAAADTTTDDTTFFDFTTATTFTDADFDDFADAFTAFAADFDAAAAFADAAFFAFATTTFADD
CHRISTY J HOWARD MORGAN MEDICAL CENTER
1021 LONG LN PO BOX 860
MADISON GA 30650-2846 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354652 CHRISTY J HOWARD 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (04/01/23 - 04/30/23) CHRISTY J HOWARD
Provider: BOULWARE, RONALD
04/04/2023 PHYSICAL THERAPY $165.33
04/11/2023 PHYSICAL THERAPY $178.00
04/18/2023 PHYSICAL THERAPY $174.00
04/20/2023 PHYSICAL THERAPY $150.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$667.33
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879645} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7867712942
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354651 Upon Receipt $0.00 $
Page 1 of 1
DFDDDTTDTTTDFTTDTTAAFFDAFFDFTDTTAFDATTTDFDAFATDTFFFFATAAADDDATTFT AFFDTTFADDADFAAFTTAAFAFFDAAAFTFDDDTAAFTFFADFAADFATTTDTFDAAAATDAAT
MARQUESIA T MATHIS-SMITH MORGAN MEDICAL CENTER
1625 GODFREY RD PO BOX 860
EATONTON GA 31024-6222 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354651 MARQUESIA T MATHIS-SMITH 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/01/24) MARQUESIA T MATHIS-SMITH
Provider: Brown, Kirk Tahama MD
07/01/2024 PHARMACY $12.00
07/01/2024 LABORATORY $329.75
07/01/2024 LAB/CHEMISTRY $568.00
07/01/2024 LAB/HEMATOLOGY $256.00
07/01/2024 DX X-RAY/CHEST $171.00
07/01/2024 EMERG ROOM $1,943.00
07/01/2024 EKG/ECG $154.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$3,433.75
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879657} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7874513738
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354649 Upon Receipt $0.00 $
Page 1 of 1
DTTADFTAAATTADFAAADDDAAFFFTDFFTAFTDDDAFDADDTDAFTAFDDFFTDFFAAFADFD TDTTDFADFDFAAATTAATFDFAAAATDTATDFADDFATDDAATFDTDTTFDDTATTTFADTFTA
JANICE J ESTEP MORGAN MEDICAL CENTER
1051 PINTAIL LN PO BOX 860
MADISON GA 30650-3248 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354649 JANICE J ESTEP 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/03/24) JANICE J ESTEP
Provider: Colasurdo, Joseph Nicholas DPM
06/03/2024 PHARMACY $178.52
06/03/2024 MED-SUR SUPPLIES $41.84
06/03/2024 NON-STER SUPPLY $31.48
06/03/2024 STERILE SUPPLY $187.45
06/03/2024 PATHOL/HYSTOL $138.00
06/03/2024 OR SERVICES $6,508.00
06/03/2024 ANESTHESIA $2,932.27
06/03/2024 DRUGS/DETAIL CODE $195.22
06/03/2024 RECOVERY ROOM $2,214.00
06/03/2024 PRO FEE/ANES CRNA $1,494.50
07/16/2024 Medicare payment -$4,365.74
07/16/2024 Contractual Allowance Adjustment -$6,771.29
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$13,921.28
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ...-$11,137.03
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879670} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629510
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354647 Upon Receipt $0.00 $
Page 1 of 1
DDADDTTFADTDAAAFDDDAFAFDAATTTDFAADDDFTTAAFTDADFAFFTAFFFFFADTDFFTF DDTDADADDAAFAFDAAAFDDATTFAFTTFFTFAFAFTDDDTFADFFDTDADDDDDTDADFTDAD
ASHLEY HAMBY MORGAN MEDICAL CENTER
105 WENTWORTH DR PO BOX 860
OXFORD GA 30054-2323 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354647 ASHLEY HAMBY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/26/24) ASHLEY HAMBY
Provider: Werkin, Jacob MD
06/26/2024 PRO FEE/CLINIC $351.52
06/26/2024 Patient payment -$45.00
Patient Balance -$45.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$351.52
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$45.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879686} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8089494174
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354646 Upon Receipt $0.00 $
Page 1 of 1
TFTTAAATFAAAAADDTFTDADFDDADDADFTTDFTAATFDFATTTDFFDDDDDDDAADFTDAFT FFFTFAFAFAFTFFFDTTDTFFDDTADFFDTTDDADADDFFTTDTTAAADDTDDTTAFFDADATF
KRISTEN L WILCOX MORGAN MEDICAL CENTER
3090 FARMINGTON RD PO BOX 860
MADISON GA 30650-2351 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354646 KRISTEN L WILCOX 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/04/24) KRISTEN L WILCOX
Provider: Ashford, William MD
06/04/2024 PHARMACY $60.00
06/04/2024 MED-SUR SUPPLIES $41.84
06/04/2024 NON-STER SUPPLY $88.48
06/04/2024 STERILE SUPPLY $403.20
06/04/2024 OR SERVICES $12,000.00
06/04/2024 ANESTHESIA $2,403.50
06/04/2024 DRUGS/DETAIL CODE $433.41
06/04/2024 RECOVERY ROOM $1,194.00
06/04/2024 PRO FEE/ANES CRNA $1,467.00
06/04/2024 Patient payment -$800.00
06/27/2024 Commercial insurance payment -$2,156.98
06/27/2024 Contractual Allowance Adjustment -$12,724.43
Patient Balance $943.02
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$18,091.43
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ...-$14,881.41
1-888-618-1683. Patient Payments/Adjustments: .............-$800.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879701} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8147740717
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354645 Upon Receipt $0.00 $
Page 1 of 1
DFADDTADFFADTTAFDFAAADDAAADFTTTDDFAADADAFDTTTFDFFTTFTDAFTFADTDDDA FAAFDTDTAFTTTDADDFFAADADDDDTFTAAADTTTDAAAFTFTTDAFFTATATFFFDFAFAFA
ANTHONY SHARPE MORGAN MEDICAL CENTER
2020 HESTER TOWN RD PO BOX 860
MADISON GA 30650-2624 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354645 ANTHONY SHARPE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (05/24/24) ANTHONY SHARPE
Provider: Urhuogo, Awharitefe MD
05/24/2024 PHARMACY $66.67
05/24/2024 STERILE SUPPLY $53.64
05/24/2024 CT SCAN/HEAD $1,545.00
05/24/2024 CT SCAN/BODY $1,224.00
05/24/2024 EMERG ROOM $2,550.00
05/24/2024 DRUGS/DETAIL CODE $421.12
05/24/2024 VACCINE ADMIN $183.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$6,043.43
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879719} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629509
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354644 Upon Receipt $0.00 $
Page 1 of 1
AAAFATATTFAFTFAFFAATADDTADDADTDDDDFTTDFAAATDATFATTTFTDAFDTFFADFAT DTDATFTFTFDFDDTAFDDFTTFTADFFTADATADFDTATTFFTDFTDDFFFTADADDTFFADDT
JACOB KITCHENS MORGAN MEDICAL CENTER
1410 GRAPEVINE TRL PO BOX 860
MONROE GA 30656-4514 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354644 JACOB KITCHENS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (12/11/23) JACOB KITCHENS
Provider: Chhabra, Anil Kumar MD
12/11/2023 DRUGS/INCIDENT RAD $500.00
12/11/2023 STERILE SUPPLY $72.00
12/11/2023 LABORATORY $146.00
12/11/2023 LAB/HEMATOLOGY $64.00
12/11/2023 CT SCAN/HEAD $1,545.00
12/11/2023 CT SCAN/BODY $6,596.00
12/11/2023 EMERG ROOM $1,714.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$10,637.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879734} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8014857869
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354642 Upon Receipt $1,766.65 $
Page 1 of 1
AADADAADFDFDDAFFTTTFFTTAADFTDTDATFATDTAAADTFAAFFFDDFFTTATAFTFDFTT ATFTTFDADDDDFAAATDTADTFFTFAFFADFDTTFAAAFAAFDFATDAADTDAFTFAAATAATT
MICHAEL DAVIS MORGAN MEDICAL CENTER
786 FOSTER ST PO BOX 860
MADISON GA 30650-1974 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354642 MICHAEL DAVIS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/20/24) MICHAEL DAVIS
Provider: Spencer, Dennis DO
Patient Balance $1,766.65
MESSAGES
We have not received payment. Please pay the current balance by the due date
shown. For questions regarding your bill, please contact our Billing office at Total Charges: .....................................$2,355.53
1-888-618-1683. Insurance Payments/Adjustments: ........-$588.88
Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $1,766.65
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879748} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8167038381
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354640 Upon Receipt $0.00 $
Page 1 of 1
ATTAAFATDFFDAFAADATTDDADTATAAFAADTFADFFFAADDFATTFDDTFDATAFFDAADFA TATDDTTDFDTAAATDAFAFFDAAFFTTTTAFFFDTFFADTATAADDFTAADDAADDTFADFFAA
JAMES E LAGUIN MORGAN MEDICAL CENTER
2561 ATHENS HWY PO BOX 860
MADISON GA 30650-3708 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354640 JAMES E LAGUIN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/24/24) JAMES E LAGUIN
Provider: Pepper, Robert Thomas MD
06/24/2024 LABORATORY $5.00
06/24/2024 LAB/CHEMISTRY $19.00
06/24/2024 CLINIC $130.00
06/24/2024 EKG/ECG $483.00
07/16/2024 Medicare payment $49.92
07/02/2024 Contractual Allowance Adjustment -$483.00
07/16/2024 Contractual Allowance Adjustment -$73.92
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$637.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ........-$507.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879763} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629505
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354638 Upon Receipt $0.00 $
Page 1 of 1
DTADTTDDDTAFTAFTDFAATATAFADAFATTTDTFTTAFDDTFDFFFADAFTDDFTFDTFDAAD TFDAFAAFATFADTDDFTTDAFDAATTFTDTDTFFDDADTDDATADAADTFFADAATTDTDDFDF
ERNEST JAMES HORTON MORGAN MEDICAL CENTER
30 BROOKWOOD DR PO BOX 860
COVINGTON GA 30014 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354638 ERNEST JAMES HORTON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/26/24) ERNEST J HORTON
Provider: Werkin, Jacob MD
06/26/2024 PRO FEE/CLINIC $486.00
06/26/2024 Patient payment -$10.00
Patient Balance -$10.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$486.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$10.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879775} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629507
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354637 Upon Receipt $0.00 $
Page 1 of 1
ADAADDTDTATFTADADAAFDADFTDDATADDDTFFDAAADDDDDADTFFFAATTFDTFFAAFTD ADAFADFTTTADTTFADAATTATFDTATFFFDATAATFDAFDDFFAFDFTTAADFFAATTTTTFD
DONNA M PITTMAN MORGAN MEDICAL CENTER
47 WATSON MILL RD PO BOX 860
COMER GA 30629-6121 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354637 DONNA M PITTMAN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/16/24) DONNA M PITTMAN
Provider: Ashford, William MD
07/16/2024 PHARMACY $576.43
07/16/2024 NON-STER SUPPLY $31.48
07/16/2024 STERILE SUPPLY $5,364.72
07/16/2024 SUPPLY/IMPLANTS $1,912.01
07/16/2024 OR SERVICES $13,800.00
07/16/2024 ANESTHESIA $3,412.97
07/16/2024 DRUGS/DETAIL CODE $222.09
07/16/2024 RECOVERY ROOM $2,214.00
07/16/2024 PRO FEE/ANES CRNA $1,467.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$29,000.70
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879787} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8065711461
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354635 Upon Receipt $0.00 $
Page 1 of 1
DFTFDTDFDATFATDDFDTAAADFTDTFFDDTFFDATFTDFAFFTTTFAATDFADDFTDTFDDAF AFTTAAATDTFFTAFFAATTFATATAADDDDDFDFFAFDTFTFTAAAATTDFDDFATAATTDFTD
KATHRYN SEYMOUR MORGAN MEDICAL CENTER
1060 WINDSOR CREEK DR PO BOX 860
MADISON GA 30650-4519 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354635 KATHRYN SEYMOUR 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (12/12/23) KATHRYN SEYMOUR
Provider: Gallo, Martin Robert MD
12/12/2023 CLINIC $155.00
12/12/2023 PRO FEE/CLINIC $613.01
12/29/2023 DRUGS/DETAIL CODE $5,036.36
12/12/2023 Patient payment -$45.00
01/04/2024 Commercial insurance payment -$103.62
01/04/2024 Contractual Allowance Adjustment -$664.39
Patient Balance -$45.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$5,804.37
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ........-$768.01
1-888-618-1683. Patient Payments/Adjustments: ...............-$45.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879809} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629504
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354634 Upon Receipt $0.00 $
Page 1 of 1
TFADFATDFDDAFFFFDTAAFATFDFADFDTDTFADDAFDTTADTDTFFFATAAADFFAFAFDDA TDFDFDFFFTATDADTTTADDFDFFATAAFADDAATFADADTTFFDFDATAAFDAFATFTDTAAF
JASON R COTTRELL SR MORGAN MEDICAL CENTER
117 WORTHAM DR PO BOX 860
BUCKHEAD GA 30625-3013 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354634 JASON R COTTRELL Sr 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (02/06/24) JASON R COTTRELL
Provider: BOULWARE, RONALD
02/06/2024 LABORATORY $79.00
02/06/2024 LAB/CHEMISTRY $335.00
02/06/2024 Patient payment -$20.00
Patient Balance -$20.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$414.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$20.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879825} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629503
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354633 Upon Receipt $0.00 $
Page 1 of 1
TDFFDFFTAFTTDDTTTFAATTDFDAAFFFTFTAATTDTTTFTAFFFTDDTTAADFAFTFFDTDD TTAADFDDADDTATTTDFTFTDAFADTDAATFAATDDFAFTFADFDTTFAFTAAATFTDADATDA
CARALYN K LEONARD MORGAN MEDICAL CENTER
1736 HODGES CIR PO BOX 860
MANSFIELD GA 30055-2645 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354633 CARALYN K LEONARD 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/12/24) CARALYN K LEONARD
Provider: LAZARUS, JOASH THEOPHILUS
07/12/2024 DRUGS/INCIDENT RAD $500.00
07/12/2024 STERILE SUPPLY $72.00
07/12/2024 LAB/CHEMISTRY $38.00
07/12/2024 CT SCAN/HEAD $3,008.00
07/12/2024 DRUGS/DETAIL CODE $14.00
07/30/2024 Medicare payment -$1,146.44
07/30/2024 Contractual Allowance Adjustment -$1,766.76
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$3,632.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: .....-$2,913.20
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879842} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7976627237
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354632 Upon Receipt $0.00 $
Page 1 of 1
FDAAADDDATDFFDTTADFDDFADDATTTAATDTFTFDDDDAAFDFTDDFATFFDTFAAFDATTD AADFTTTATDTFFTAFFDAAATFADDAADTFFTDDATAADAFDAAADADATDAAFDDFTATFFFT
CHRISTINE WHITE MORGAN MEDICAL CENTER
545 MAPLE ST LOT 7 PO BOX 860
MADISON GA 30650-1751 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354632 CHRISTINE WHITE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (01/22/24) CHRISTINE WHITE
Provider: Fletcher, David Troy MD
01/22/2024 LABORATORY $257.00
01/22/2024 LAB/CHEMISTRY $202.00
01/22/2024 LAB/HEMATOLOGY $64.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$523.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879849} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8039630932
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354631 Upon Receipt $0.00 $
Page 1 of 1
DTDTAFADFAADDFAADAATDADDAATATAFATTAADTDAFFADFATTDTFAATTAAADTFTFFF DAFDTTDFDFTDDFTFTDFFFTFDFFFTATFAFFTAFDAATAFFTFDFAFAADADFFTAFFFTAT
WAYNE W MOORE MORGAN MEDICAL CENTER
1700 APALACHEE WOODS TRL PO BOX 860
BUCKHEAD GA 30625-1540 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354631 WAYNE W MOORE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (05/21/24) WAYNE W MOORE
Provider: Long, Leah LPN
05/21/2024 NON-STER SUPPLY $31.48
05/21/2024 STERILE SUPPLY $23.28
05/21/2024 CLINIC $1,123.00
05/21/2024 DRUGS/DETAIL CODE $45,144.29
07/16/2024 Medicare payment -$14,526.59
07/16/2024 Contractual Allowance Adjustment -$22,531.04
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$46,322.05
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ...-$37,057.63
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879858} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629500
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354630 Upon Receipt $0.00 $
Page 1 of 1
DDFATDDAFDDTAFFTDFADDAFFFTFTDADTAATTAFTDFTTAFAADTFTTTADTFAADDAFFD FTTTDFTTFFDATFATAFDADDATTFDFDATADTDDATATAATTDTTDTFDFDATADFFFAAFTA
CHANDLER J PIKE MORGAN MEDICAL CENTER
386 ACADEMY ST PO BOX 860
MADISON GA 30650-1540 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354630 CHANDLER J PIKE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/19/24) CHANDLER J PIKE
Provider: Hall, Pamela G MD
07/19/2024 SCRN MAMMOGRAPHY $298.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$298.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879878} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7877214022
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354628 Upon Receipt $0.00 $
Page 1 of 1
FADTDAAFTDDFDTTDFAFDADDATFADTTDTTDDDAFFTDFDATDDFATTATAAFADDADDTDF FDDFFDAAAAAAFDFTFTFTTFDTDTDTDFATATFTTDDDFDAADTFTDDTDTDTDTFDDATDFF
BETTY B CONNER MORGAN MEDICAL CENTER
PO BOX 102 PO BOX 860
RUTLEDGE GA 30663-0102 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354628 BETTY B CONNER 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (01/05/24) BETTY B CONNER
Provider: Wingate III, Harry Lynnwood MD
01/05/2024 IV SOLUTIONS $44.02
01/05/2024 NON-STER SUPPLY $31.48
01/05/2024 STERILE SUPPLY $23.28
01/05/2024 LABORATORY $146.00
01/05/2024 LAB/CHEMISTRY $19.00
01/05/2024 LAB/HEMATOLOGY $64.00
01/05/2024 DX X-RAY $230.00
01/05/2024 CT SCAN/HEAD $1,545.00
01/05/2024 CT SCAN/BODY $1,224.00
01/05/2024 EMERG ROOM $2,937.00
01/05/2024 DRUGS/DETAIL CODE $24.00
01/05/2024 EKG/ECG $154.00
02/06/2024 Medicare payment -$2,001.89
02/06/2024 Contractual Allowance Adjustment -$3,197.33
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$6,441.78
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: .....-$5,199.22
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879892} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8116668747
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354627 Upon Receipt $0.00 $
Page 1 of 1
FDAATDTTFFDDDAFADDAATDDDFDADDAADAAATTADTAFFTFFTTFADFDTFFDFTFATDFD DFAAAAFDTAFDADDFDADDAATDATFFADDTTFAFDTDFDDDDTFAFFDFTADDTADTDFDTDD
LAURIE DONOVAN MORGAN MEDICAL CENTER
1000 LULLWATER CT PO BOX 860
WHITE PLAINS GA 30678-3002 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354627 LAURIE DONOVAN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (05/14/24) LAURIE DONOVAN
Provider: Gallo, Martin Robert MD
05/14/2024 CLINIC $130.00
05/14/2024 PRO FEE/CLINIC $338.83
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$468.83
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879918} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8196085925
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354626 Upon Receipt $0.00 $
Page 1 of 1
ADTDDFDADAAFTDTTTTFTDFFFFFTDDAFDAATFDTTTADTAFADTFFDAFADFDAATFAFDF TFAFDTFDADATATTDDAAFAFAFFTTAATADTFTTDATFDFAFADDAFTATTTADADDADDAFA
SHANICE TEASLEY MORGAN MEDICAL CENTER
131 JACKSON ST PO BOX 860
BOWMAN GA 30624-1926 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354626 SHANICE TEASLEY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/25/24) SHANICE TEASLEY
Provider: Werkin, Jacob MD
07/25/2024 PHARMACY $576.44
07/25/2024 MED-SUR SUPPLIES $41.84
07/25/2024 NON-STER SUPPLY $61.08
07/25/2024 STERILE SUPPLY $1,254.46
07/25/2024 LAB/CHEMISTRY $54.00
07/25/2024 PATHOL/HYSTOL $138.00
07/25/2024 OR SERVICES $23,200.00
07/25/2024 ANESTHESIA $5,672.26
07/25/2024 DRUGS/DETAIL CODE $1,258.83
07/25/2024 RECOVERY ROOM $2,214.00
07/25/2024 PRO FEE/ANES CRNA $1,467.00
07/25/2024 PRO FEE/OR $1,774.39
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$37,712.30
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879932} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8007639078
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354625 Upon Receipt $0.00 $
Page 1 of 1
FFFTDTTFTFDAFFDDTDTTFFAAATTFATFTADFADAFFAAFTAFTAAFDDDATDFFFFDFADF ADDATFAATDFFFTAAFTTATAFATTADDADDATDFTFTDFFDTFATDDTDDTTFTTFTATTDDT
TRUDY WHISNANT MORGAN MEDICAL CENTER
5960 BETHANY RD PO BOX 860
BUCKHEAD GA 30625-1928 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354625 TRUDY WHISNANT 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (04/23/24) TRUDY WHISNANT
Provider: Werkin, Jacob MD
04/23/2024 CLINIC $130.00
04/23/2024 PRO FEE/CLINIC $221.52
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$351.52
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879946} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629497
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354624 Upon Receipt $0.00 $
Page 1 of 1
TFFAFATDTDAAADDFTFTAFFDADATFFTAADFTFFDDFDTTFAFFFFTFDFDTTDFTFFFDDT ATTDADTTDTTFTAFAAFATDTTADFAADFFFDTFAAAFTATFAFAFTTATFFFFFDFATTADAD
JOHN MOSS MORGAN MEDICAL CENTER
253 HIGHWAY 186 PO BOX 860
GOOD HOPE GA 30641-1403 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354624 JOHN MOSS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (05/29/24) JOHN MOSS
Provider: Socoloff, David Neal DO
05/29/2024 PHARMACY $24.00
05/29/2024 MED-SUR SUPPLIES $41.84
05/29/2024 NON-STER SUPPLY $31.48
05/29/2024 STERILE SUPPLY $26.92
05/29/2024 LAB/CHEMISTRY $87.00
05/29/2024 LAB/HEMATOLOGY $64.00
05/29/2024 PATHOL/HYSTOL $138.00
05/29/2024 OR SERVICES $2,842.64
05/29/2024 ANESTHESIA $2,115.08
05/29/2024 DRUGS/DETAIL CODE $101.60
05/29/2024 RECOVERY ROOM $1,194.00
05/29/2024 PRO FEE/ANES CRNA $1,466.96
07/30/2024 Medicare payment -$3,421.63
07/30/2024 Contractual Allowance Adjustment -$3,973.92
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$8,133.52
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: .....-$7,395.55
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879957} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8186641910
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354622 Upon Receipt $0.00 $
Page 1 of 1
FDDFDDDTDATFTTTTFFFTDAFADFFTTAATATTFFDTADFDTFDFDFAFAAAAADFTFTTTAD TAFTFADFFTDTDADDTDTDFDDFAFTDADTFFFADFFFATTTDADAAAAFAFFAAFDFTDFTTF
REBECCA FARLEY MORGAN MEDICAL CENTER
2011 FIELDCREST LN PO BOX 860
MADISON GA 30650-4381 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354622 REBECCA FARLEY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/01/24) REBECCA FARLEY
Provider: Cannington, Sara Danielle FNP
07/01/2024 LABORATORY $189.00
07/01/2024 LAB/CHEMISTRY $284.00
07/01/2024 LAB/HEMATOLOGY $64.00
07/01/2024 PRO FEE/OUTPT $390.08
07/01/2024 Patient payment -$20.00
Patient Balance -$20.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$927.08
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$20.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879972} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7863011343
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354620 Upon Receipt $0.00 $
Page 1 of 1
FAFAATATFDFTATTTAADATFATAAFTFAATAFAAFTDTATDDDFTADADADDDDDDADFDFFF FADAFATAAADAFDFDFDDTADDTTDDDDDTAADFDTDFDADTTTTAADFDDAFTTDADDAFFDF
MARTHA ANN WILLIS MORGAN MEDICAL CENTER
PO BOX 901 PO BOX 860
MONTICELLO GA 31064-0901 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354620 MARTHA ANN WILLIS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (04/11/24) MARTHA A WILLIS
Provider: Chhabra, Anil Kumar MD
04/11/2024 PHARMACY $12.00
04/11/2024 DX X-RAY $276.00
04/11/2024 EMERG ROOM $1,628.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,916.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879985} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7976627237
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354619 Upon Receipt $0.00 $
Page 1 of 3
TADDDAAADFATAAFFDATAATDAADFFFDDFTFTFTFAFADDTATFAATDDTTADTDDTADFFA DTAFADDDTATDADDADFFDTTTDFDFAAFFATAAADTFFTDFFDFFDFFATAFDDFTTDFATFD
CHRISTINE WHITE MORGAN MEDICAL CENTER
545 MAPLE ST LOT 7 PO BOX 860
MADISON GA 30650-1751 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354619 CHRISTINE WHITE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (12/15/23 - 01/04/24) CHRISTINE WHITE
Provider: Beharrysingh, Rudra MD
12/14/2023 MED-SUR-GY/PVT $1,654.00
12/14/2023 PHARMACY $84.00
12/14/2023 STERILE SUPPLY $27.00
12/14/2023 LAB/HEMATOLOGY $64.00
12/15/2023 MED-SUR-GY/PVT $1,654.00
12/15/2023 PHARMACY $144.00
12/15/2023 LAB/CHEMISTRY $75.00
12/15/2023 PHYS THERP/EVAL $190.00
12/15/2023 OCCUPATION THER $88.00
12/15/2023 OCCUP THERP/EVAL $203.00
12/16/2023 MED-SUR-GY/PVT $1,654.00
12/16/2023 PHARMACY $156.00
12/16/2023 LAB/CHEMISTRY $87.00
12/16/2023 PHYSICAL THERAPY $88.00
12/16/2023 OCCUPATION THER $176.00
12/17/2023 MED-SUR-GY/PVT $1,654.00
12/17/2023 PHARMACY $180.00
12/17/2023 STERILE SUPPLY $7.00
12/18/2023 MED-SUR-GY/PVT $1,654.00
12/18/2023 PHARMACY $216.00
12/18/2023 LABORATORY $146.00
12/18/2023 LAB/HEMATOLOGY $64.00
12/18/2023 DX X-RAY $154.00
12/18/2023 OCCUPATION THER $61.00
12/19/2023 MED-SUR-GY/PVT $1,654.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$45,385.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120879985}
Page 2 of 3
STATEMENT NUMBER STATEMENT DATE
300354619 08/07/2024
DUE DATE AMOUNT DUE
PATIENT STATEMENT Upon Receipt $0.00
For billing questions, please call: ACCOUNT NAME
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm CHRISTINE WHITE
Payments/ Patient
Date Service Description Charges
Adjustments Balance
12/19/2023 PHARMACY $216.00
12/19/2023 PHYSICAL THERAPY $167.00
12/19/2023 OCCUPATION THER $242.00
12/20/2023 MED-SUR-GY/PVT $1,654.00
12/20/2023 PHARMACY $240.00
12/20/2023 LAB/CHEMISTRY $87.00
12/20/2023 PHYSICAL THERAPY $264.00
12/20/2023 OCCUPATION THER $210.00
12/21/2023 MED-SUR-GY/PVT $1,654.00
12/21/2023 PHARMACY $180.00
12/21/2023 STERILE SUPPLY $21.00
12/21/2023 PHYSICAL THERAPY $176.00
12/22/2023 MED-SUR-GY/PVT $1,654.00
12/22/2023 PHARMACY $180.00
12/22/2023 PHYSICAL THERAPY $88.00
12/22/2023 PHYS THERP/GROUP $112.00
12/22/2023 OCCUPATION THER $112.00
12/23/2023 MED-SUR-GY/PVT $1,654.00
12/23/2023 PHARMACY $180.00
12/24/2023 MED-SUR-GY/PVT $1,654.00
12/24/2023 PHARMACY $228.00
12/24/2023 STERILE SUPPLY $7.00
12/25/2023 MED-SUR-GY/PVT $1,654.00
12/25/2023 PHARMACY $216.00
12/25/2023 LABORATORY $146.00
12/25/2023 LAB/HEMATOLOGY $64.00
12/26/2023 MED-SUR-GY/PVT $1,654.00
12/26/2023 PHARMACY $168.00
12/26/2023 STERILE SUPPLY $35.00
12/26/2023 PHYSICAL THERAPY $237.00
12/26/2023 OCCUPATION THER $149.00
12/27/2023 MED-SUR-GY/PVT $1,654.00
12/27/2023 PHARMACY $132.00
12/27/2023 LAB/CHEMISTRY $19.00
12/28/2023 MED-SUR-GY/PVT $1,654.00
12/28/2023 PHARMACY $156.00
12/28/2023 PHYSICAL THERAPY $325.00
12/28/2023 OCCUPATION THER $122.00
12/29/2023 MED-SUR-GY/PVT $1,654.00
12/29/2023 PHARMACY $192.00
12/29/2023 PHYSICAL THERAPY $264.00
12/29/2023 PHYS THERP/GROUP $112.00
12/29/2023 OCCUPATION THER $288.00
12/30/2023 MED-SUR-GY/PVT $1,654.00
12/30/2023 PHARMACY $192.00
12/30/2023 PHYSICAL THERAPY $176.00
12/31/2023 MED-SUR-GY/PVT $1,654.00
12/31/2023 PHARMACY $192.00
01/01/2024 MED-SUR-GY/PVT $1,654.00
01/01/2024 PHARMACY $180.00
01/01/2024 LABORATORY $146.00
01/01/2024 LAB/HEMATOLOGY $64.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
APD{3120879985}
Page 3 of 3
STATEMENT NUMBER STATEMENT DATE
300354619 08/07/2024
DUE DATE AMOUNT DUE
PATIENT STATEMENT Upon Receipt $0.00
For billing questions, please call: ACCOUNT NAME
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm CHRISTINE WHITE
Payments/ Patient
Date Service Description Charges
Adjustments Balance
01/01/2024 PHYSICAL THERAPY $237.00
01/01/2024 OCCUPATION THER $210.00
01/02/2024 MED-SUR-GY/PVT $1,654.00
01/02/2024 PHARMACY $180.00
01/02/2024 PHYSICAL THERAPY $414.00
01/02/2024 OCCUPATION THER $149.00
01/03/2024 MED-SUR-GY/PVT $1,654.00
01/03/2024 PHARMACY $204.00
01/03/2024 PHYSICAL THERAPY $441.00
01/03/2024 OCCUPATION THER $237.00
01/04/2024 PHARMACY $84.00
Patient Balance $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
APD{3120880000} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7892815388
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354615 Upon Receipt $0.00 $
Page 1 of 1
FFADAADTATDDAATDTDFAAFDFADTFTDATDDDAFTTFDTTFAAAFTAADFADDDTFTFDFTF DDFTTFFFDFFDDFTATTDFDAFDAAFDAADTFATFFTTADAFDDFTDADFAFTDAATAFFTTTT
GRACIE C CLARK MORGAN MEDICAL CENTER
1230 LAMBERT LN PO BOX 860
MADISON GA 30650-3937 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354615 GRACIE C CLARK 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/01/24) GRACIE C CLARK
Provider: Socoloff, David Neal DO
07/01/2024 DRUGS/INCIDENT RAD $500.00
07/01/2024 STERILE SUPPLY $72.00
07/01/2024 LAB/CHEMISTRY $38.00
07/01/2024 CT SCAN/BODY $2,946.00
07/01/2024 DRUGS/DETAIL CODE $10.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$3,566.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880015} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8186742342
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354614 Upon Receipt $0.00 $
Page 1 of 1
DTFAFDAATTAAADFTTFFTTAFFFADAAFATTTATTTTDFFAADTATAFATDAADTDTFDAADA FFTDDTATFFAATFADAAFAFFATDADADTATDDDTADTTFATATTDATDTFFTTFTAFFADFAA
SHIRLEY J DUNN MORGAN MEDICAL CENTER
1911 CAREY STATION RD PO BOX 860
GREENSBORO GA 30642-2681 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354614 SHIRLEY J DUNN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/08/24) SHIRLEY J DUNN
Provider: Cannington, Sara Danielle FNP
07/08/2024 CLINIC $130.00
07/08/2024 PRO FEE/CLINIC $176.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880030} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8168646642
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354613 Upon Receipt $0.00 $
Page 1 of 1
DFATFADFTDDDADAFFDDTAATTTDDDFDADADAAFTDFDFTFAAFFTFFTDFDTFDFTADFAA ADDTDFAAFDFADAATATTADFFATATDDATDFTDDAATTFAATFTTDTTDFDTAATAFATTFTA
LYNDA S THOMAS MORGAN MEDICAL CENTER
1706 FOUR LAKES DR PO BOX 860
MADISON GA 30650-4266 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354613 LYNDA S THOMAS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/10/24) LYNDA S THOMAS
Provider: Hall, Pamela G MD
07/10/2024 DX X-RAY $504.00
07/10/2024 SCRN MAMMOGRAPHY $298.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$802.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880045} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629490
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354608 Upon Receipt $0.00 $
Page 1 of 1
FDTDTDFTADFTDTAATTATDDATTATAAAFTTTADFFDTDTATFTDTFTFFATTAATDFFATFT TFADTTFDDDADTATFTAAFFAAFFAAAATFDDFTAFFTADADFAFDFATAADTFFATAADDAAT
ROBERT S MICHAEL MORGAN MEDICAL CENTER
PO BOX 17 PO BOX 860
BUCKHEAD GA 30625-0017 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354608 ROBERT S MICHAEL 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/28/24) ROBERT S MICHAEL
Provider: Wingate III, Harry Lynnwood MD
06/28/2024 DRUGS/INCIDENT RAD $500.00
06/28/2024 STERILE SUPPLY $72.00
06/28/2024 LABORATORY $146.00
06/28/2024 LAB/HEMATOLOGY $64.00
06/28/2024 CT SCAN/HEAD $4,553.00
06/28/2024 EMERG ROOM $2,573.00
06/28/2024 DRUGS/DETAIL CODE $14.00
06/28/2024 EKG/ECG $154.00
07/16/2024 Medicare payment -$2,573.78
07/16/2024 Contractual Allowance Adjustment -$3,929.02
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$8,076.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: .....-$6,502.80
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880062} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8043958051
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354607 Upon Receipt $0.00 $
Page 1 of 1
FATTATTFTATATADFAFTAAAFTAFDFFTFAFDAAAFDAAFTTATDFTAFADADFFFFADFTDT TAFAAADFTTDDFTDFDDTDATDFADADADDFAFAFDAFFTDFDAFAAFAFTAFFTFTTTDFADD
ELIZABETH C CROSS MORGAN MEDICAL CENTER
1410 PONDER PINES RD PO BOX 860
MADISON GA 30650-5574 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354607 ELIZABETH C CROSS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/10/24) ELIZABETH C CROSS
Provider: Chhabra, Anil Kumar MD
07/10/2024 PHARMACY $12.00
07/10/2024 MED-SUR SUPPLIES $13.36
07/10/2024 DX X-RAY $166.00
07/10/2024 DX X-RAY/CHEST $259.00
07/10/2024 EMERG ROOM $2,356.00
07/29/2024 Medicare payment -$880.07
07/29/2024 Contractual Allowance Adjustment -$1,365.02
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$2,806.36
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: .....-$2,245.09
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880076} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7955373286
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354602 Upon Receipt $0.00 $
Page 1 of 1
FFTDTTTDATTTTFTDFAFDFFFFATDDTTFADDFFDADTATTTTFFFADDATATAFDATFDAAD ATTFFDTTATTAATFTFFATTDTADDTADFAFTTFTTFFDADTAFTFDDATDAFADDADTTADFF
KRISTI L STINNETT MORGAN MEDICAL CENTER
1130 ACADEMY LN PO BOX 860
RUTLEDGE GA 30663-2643 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354602 KRISTI L STINNETT 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/28/24) KRISTI L STINNETT
Provider: Fletcher, David Troy MD
06/28/2024 STERILE SUPPLY $72.00
06/28/2024 CT SCAN/HEAD $1,725.00
06/28/2024 DRUGS/DETAIL CODE $500.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$2,297.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880088} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8107718859
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354601 Upon Receipt $0.00 $
Page 1 of 1
FATTAATTAFFDAFTDATDDFADFDTTDATFAAFFFTFFFFDTATDAAAAFFFADTDFADFTDTT DTADFDDDFATTTFDTTFFDDDTDFFDAAFAADAATFDFATTAFDDFTAFAADFTFFTFDFAAAF
MIRTICE M HICKS MORGAN MEDICAL CENTER
1190 MIDWAY CHURCH RD PO BOX 860
NEWBORN GA 30056-2714 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354601 MIRTICE M HICKS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/10/24) MIRTICE M HICKS
Provider: Pepper, Robert Thomas MD
07/10/2024 LABORATORY $5.00
07/10/2024 LAB/CHEMISTRY $25.00
07/10/2024 CLINIC $130.00
07/10/2024 PRO FEE/CLINIC $176.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$336.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880105} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8115362780
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354598 Upon Receipt $25.06 $
Page 1 of 1
FDDFDDFFDTATDFTATTDFTADTDAATDFTDAADAFDTTDDATFTADDDFADDTFTATDATTAF FADTAATADADFDFFFADDTFTDTTFFDDDDAFDFFATFTATDTTAAFTFDFFFDADAADAFFTD
ASIA WEAVER MORGAN MEDICAL CENTER
1315 BILLUPS ST PO BOX 860
MADISON GA 30650-1126 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354598 ASIA WEAVER 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (03/04/24) ASIA WEAVER
Provider: Zant Jr, Walter Daniel MD
Patient Balance $25.06
MESSAGES
We have not received payment. Please pay the current balance by the due date
shown. For questions regarding your bill, please contact our Billing office at Total Charges: ........................................$147.00
1-888-618-1683. Insurance Payments/Adjustments: ........-$121.94
Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $25.06
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880120} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629484
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354595 Upon Receipt $0.00 $
Page 1 of 1
AAFFFAFATDDTTDDFATDAAFDTDFDADTFFFFATATATDADAAFDFDFTFFDDAAFAFAFTFA FFTFTTATTFAFADAFFAFAAAATDTFADTFTTDDATDTDFFFATADADDTDATDDTATFADDFT
KATHY STONE RICE MORGAN MEDICAL CENTER
1641 HARDEMAN MILL RD PO BOX 860
GOOD HOPE GA 30641-2622 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354595 KATHY STONE RICE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/16/24 - 07/17/24) KATHY S RICE
Provider: Urhuogo, Awharitefe MD
07/16/2024 CT SCAN/HEAD $1,545.00
07/16/2024 EMERG ROOM $1,943.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$3,488.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880136} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7987566228
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354590 Upon Receipt $0.00 $
Page 1 of 1
AAFTTTTFTDTDFATFTAFDFAFFFFTDTDDADFAFFAFDAATFATAFFADDDAADDFFATFAAT DDFADFFFAFFTFDTTDTDFTFFDATDDAATTAATDDTTFDFTDDDTTFDFTATTTADDFFTADA
JERRY ECHOLS MORGAN MEDICAL CENTER
1401 MOUNT VERNON RD PO BOX 860
MADISON GA 30650-2658 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354590 JERRY ECHOLS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/29/24) JERRY ECHOLS
Provider: Werkin, Jacob MD
07/29/2024 PHARMACY $24.00
07/29/2024 NON-STER SUPPLY $31.48
07/29/2024 STERILE SUPPLY $26.92
07/29/2024 LAB/CHEMISTRY $87.00
07/29/2024 PATHOL/HYSTOL $138.00
07/29/2024 OR SERVICES $2,842.64
07/29/2024 ANESTHESIA $1,057.54
07/29/2024 DRUGS/DETAIL CODE $48.80
07/29/2024 RECOVERY ROOM $1,194.00
07/29/2024 EKG/ECG $154.00
07/29/2024 PRO FEE/ANES CRNA $1,467.00
07/29/2024 PRO FEE/OR $670.71
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$7,742.09
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880150} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8038221733
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354587 Upon Receipt $0.00 $
Page 1 of 1
DTDFFFFTATAAADFADDTDTTAFTFDDTFFDTAFTDDFFFFAAFDFTAFADDTTDTFDTAAFAT TDFFADFFTTADFTDADTADTADFFTATAFFDTAAADFDFDDFFFFFDFTATADFDATTTDTTFD
KRYSTA WILLIAMS MORGAN MEDICAL CENTER
1030 WEAVER JONES RD PO BOX 860
RUTLEDGE GA 30663-2987 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354587 KRYSTA WILLIAMS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/09/24) KRYSTA WILLIAMS
Provider: MCINTOSH, ABRAHAM S
07/09/2024 ULTRASOUND $369.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$369.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880160} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629480
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354585 Upon Receipt $0.00 $
Page 1 of 3
AFTTATAFTFFAFFTDTTFTFAFFDTADTTTDTFFATTDDDDFATAFAFTDTDDTTTATADDFAA AFTAFAATATFAATFDFATTAFTATTTFDDTDADFDTADDFDTTATAADTDDADATTADTTDFDF
MICHAEL A HENSLER MORGAN MEDICAL CENTER
PO BOX 821 PO BOX 860
MADISON GA 30650-0821 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354585 MICHAEL A HENSLER 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/09/24 - 07/26/24) MICHAEL A HENSLER
Provider: Johnson, Jeffery Irwin MD
07/09/2024 MED-SUR-GY/PVT $1,654.00
07/09/2024 PHARMACY $191.76
07/09/2024 STERILE SUPPLY $63.00
07/09/2024 PULMONARY FUNC $190.00
07/10/2024 MED-SUR-GY/PVT $1,654.00
07/10/2024 PHARMACY $387.87
07/10/2024 STERILE SUPPLY $216.00
07/10/2024 LAB/CHEMISTRY $87.00
07/10/2024 LAB/HEMATOLOGY $64.00
07/10/2024 PHYS THERP/EVAL $190.00
07/10/2024 OCCUPATION THER $138.00
07/10/2024 OCCUP THERP/EVAL $203.00
07/11/2024 MED-SUR-GY/PVT $1,654.00
07/11/2024 PHARMACY $411.87
07/11/2024 STERILE SUPPLY $216.00
07/11/2024 LAB/CHEMISTRY $87.00
07/11/2024 LAB/HEMATOLOGY $64.00
07/11/2024 OCCUPATION THER $280.00
07/12/2024 MED-SUR-GY/PVT $1,654.00
07/12/2024 PHARMACY $425.47
07/12/2024 NON-STER SUPPLY $36.00
07/12/2024 STERILE SUPPLY $216.00
07/12/2024 PHYSICAL THERAPY $134.00
07/12/2024 PHYS THERP/GROUP $112.00
07/12/2024 OCCUPATION THER $112.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$47,471.51
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880160}
Page 2 of 3
STATEMENT NUMBER STATEMENT DATE
300354585 08/07/2024
DUE DATE AMOUNT DUE
PATIENT STATEMENT Upon Receipt $0.00
For billing questions, please call: ACCOUNT NAME
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm MICHAEL A HENSLER
Payments/ Patient
Date Service Description Charges
Adjustments Balance
07/13/2024 MED-SUR-GY/PVT $1,654.00
07/13/2024 PHARMACY $459.87
07/13/2024 STERILE SUPPLY $216.00
07/13/2024 PHYSICAL THERAPY $171.00
07/13/2024 PULMONARY FUNC $190.00
07/14/2024 MED-SUR-GY/PVT $1,654.00
07/14/2024 PHARMACY $483.87
07/14/2024 NON-STER SUPPLY $18.00
07/14/2024 STERILE SUPPLY $216.00
07/15/2024 MED-SUR-GY/PVT $1,654.00
07/15/2024 PHARMACY $471.87
07/15/2024 LABORATORY $146.00
07/15/2024 LAB/HEMATOLOGY $64.00
07/15/2024 PHYSICAL THERAPY $390.00
07/15/2024 OCCUPATION THER $271.00
07/15/2024 PULMONARY FUNC $190.00
07/16/2024 MED-SUR-GY/PVT $1,654.00
07/16/2024 PHARMACY $387.87
07/16/2024 LAB/CHEMISTRY $150.00
07/16/2024 PHYSICAL THERAPY $344.00
07/16/2024 OCCUPATION THER $287.00
07/16/2024 PULMONARY FUNC $190.00
07/17/2024 MED-SUR-GY/PVT $1,654.00
07/17/2024 PHARMACY $471.87
07/17/2024 PULMONARY FUNC $190.00
07/18/2024 MED-SUR-GY/PVT $1,654.00
07/18/2024 PHARMACY $483.87
07/18/2024 LAB/CHEMISTRY $87.00
07/18/2024 PHYSICAL THERAPY $256.00
07/18/2024 OCCUPATION THER $271.00
07/19/2024 MED-SUR-GY/PVT $1,654.00
07/19/2024 PHARMACY $459.99
07/19/2024 STERILE SUPPLY $216.00
07/19/2024 PHYS THERP/GROUP $112.00
07/19/2024 OCCUPATION THER $112.00
07/19/2024 PULMONARY FUNC $190.00
07/20/2024 MED-SUR-GY/PVT $1,654.00
07/20/2024 PHARMACY $459.99
07/20/2024 PULMONARY FUNC $190.00
07/21/2024 MED-SUR-GY/PVT $1,654.00
07/21/2024 PHARMACY $447.87
07/21/2024 STERILE SUPPLY $369.00
07/21/2024 PULMONARY FUNC $190.00
07/22/2024 MED-SUR-GY/PVT $1,654.00
07/22/2024 PHARMACY $447.87
07/22/2024 PHYSICAL THERAPY $390.00
07/22/2024 OCCUPATION THER $210.00
07/23/2024 MED-SUR-GY/PVT $1,654.00
07/23/2024 PHARMACY $423.87
07/23/2024 STERILE SUPPLY $216.00
07/23/2024 LABORATORY $146.00
07/23/2024 LAB/HEMATOLOGY $64.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
APD{3120880160}
Page 3 of 3
STATEMENT NUMBER STATEMENT DATE
300354585 08/07/2024
DUE DATE AMOUNT DUE
PATIENT STATEMENT Upon Receipt $0.00
For billing questions, please call: ACCOUNT NAME
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm MICHAEL A HENSLER
Payments/ Patient
Date Service Description Charges
Adjustments Balance
07/23/2024 PHYSICAL THERAPY $423.00
07/23/2024 OCCUPATION THER $287.00
07/24/2024 MED-SUR-GY/PVT $1,654.00
07/24/2024 PHARMACY $471.87
07/24/2024 PHYSICAL THERAPY $414.00
07/24/2024 OCCUPATION THER $298.00
07/25/2024 MED-SUR-GY/PVT $1,654.00
07/25/2024 PHARMACY $351.99
07/25/2024 DRUGS/INCIDENT RAD $320.00
07/25/2024 PHYSICAL THERAPY $116.00
07/25/2024 OCCUPATION THER $149.00
07/25/2024 PULMONARY FUNC $190.00
07/25/2024 MRI- Other $1,213.00
07/26/2024 PHARMACY $243.87
Patient Balance $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
APD{3120880174} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8202926216
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354584 Upon Receipt $0.00 $
Page 1 of 1
DAAFTTADFDFDDDDDFAADFTAAATTDDTFAFDTFDTFTADAAADAADDTADTTATDDTDFTAT AADDDTTAFDTADAADADAAFDFADFTTDTAFDDDTAFATAAAAATDFTATFDAAFDAFATFFAA
JOSEPH MCNAIR MORGAN MEDICAL CENTER
1630 BROWNWOOD RD PO BOX 860
MADISON GA 30650-4501 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354584 JOSEPH MCNAIR 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/09/24) JOSEPH MCNAIR
Provider: Werkin, Jacob MD
07/09/2024 NON-STER SUPPLY $7.00
07/09/2024 LABORATORY $155.00
07/09/2024 PRO FEE/OUTPT $306.15
07/09/2024 PRO FEE/CLINIC $273.42
07/17/2024 Contractual Allowance Adjustment -$7.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$741.57
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ............-$7.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880195} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8191463642
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354583 Upon Receipt $151.79 $
Page 1 of 1
TFTTDTTTADTFFTADFDFTFFDFATADATTTFDDFTTFDATFTADDADFTTTATDDDTTFFTDA TTATTFDDDDDDTATATFTFDTAFAFAFAADFFATFFAAATADDFFTDAAFADAFAFTAADAATT
SHELLY PROTO MORGAN MEDICAL CENTER
173 N SUGAR CREEK RD PO BOX 860
BUCKHEAD GA 30625-2537 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354583 SHELLY PROTO 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (04/04/24) SHELLY PROTO
Provider: DIXON, JENNIFER
Patient Balance $151.79
MESSAGES
We have not received payment. Please pay the current balance by the due date
shown. For questions regarding your bill, please contact our Billing office at Total Charges: .....................................$1,197.00
1-888-618-1683. Insurance Payments/Adjustments: .....-$1,045.21
Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $151.79
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880210} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7994489887
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354582 Upon Receipt $0.00 $
Page 1 of 2
AAFDFAFAFTAADTFDTAFDFTDFTDAADTTADFDAATATAFDTTTTAFDFFADAFTTAFDDFDT FTTATFTTTFDFADAAFFDATTATTDFFDADAATDFTTADAFDTDATDDFDDTADTDFTFAADDT
ROOSEVELT EVANS MORGAN MEDICAL CENTER
2036 S MAIN ST PO BOX 860
MADISON GA 30650-2054 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354582 ROOSEVELT EVANS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (09/10/23 - 09/13/23) ROOSEVELT EVANS
Provider: Chhabra, Anil Kumar MD
09/10/2023 MED-SUR-GY/PVT $1,379.00
09/10/2023 PHARMACY $294.01
09/10/2023 STERILE SUPPLY $27.00
09/10/2023 RESPIRATORY SVC $18.00
09/10/2023 INHALATION SVC $1,083.00
09/11/2023 MED-SUR-GY/PVT $1,379.00
09/11/2023 PHARMACY $900.91
09/11/2023 LAB/HEMATOLOGY $64.00
09/11/2023 INHALATION SVC $148.00
09/11/2023 SPEECH PATHOL $194.00
09/11/2023 SPEECH PATH/EVAL $165.00
09/12/2023 MED-SUR-GY/PVT $1,379.00
09/12/2023 PHARMACY $840.44
09/12/2023 STERILE SUPPLY $358.00
09/12/2023 LAB/CHEMISTRY $477.00
09/12/2023 LAB/HEMATOLOGY $64.00
09/12/2023 CT SCAN/BODY $1,188.00
09/12/2023 INHALATION SVC $787.00
09/12/2023 SPEECH PATHOL $194.00
09/13/2023 PHARMACY $454.04
09/13/2023 STERILE SUPPLY $27.00
09/13/2023 LABORATORY $146.00
09/13/2023 LAB/CHEMISTRY $123.00
09/13/2023 LAB/HEMATOLOGY $64.00
09/13/2023 SPEECH PATHOL $194.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$11,947.40
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880210}
Page 2 of 2
STATEMENT NUMBER STATEMENT DATE
300354582 08/07/2024
DUE DATE AMOUNT DUE
PATIENT STATEMENT Upon Receipt $0.00
For billing questions, please call: ACCOUNT NAME
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm ROOSEVELT EVANS
Payments/ Patient
Date Service Description Charges
Adjustments Balance
09/22/2023 Medicare payment $0.00
Patient Balance $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
APD{3120880227} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8118275482
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354580 Upon Receipt $0.00 $
Page 1 of 1
TTATADDADADDAFATTFATTFDDDFTFTADFFTTFTDDDADDFDDADTFFTFFDTDTFTFADFF DAFFDTDFAFTTFDTDDDFFADFDFDDTATAATFTTDDAFTFAFTDDAFFATTATDFDDFFFAFA
EMORY GARY STEWART MORGAN MEDICAL CENTER
1170 SULGRAVE DR PO BOX 860
MADISON GA 30650-4614 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354580 EMORY GARY STEWART 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (04/01/24) EMORY G STEWART
Provider: Long, Leah LPN
04/01/2024 STERILE SUPPLY $40.28
04/01/2024 CLINIC $698.00
04/01/2024 DRUGS/DETAIL CODE $600.00
04/25/2024 Medicare payment -$419.69
05/02/2024 Commercial insurance payment -$267.66
07/31/2024 Medicare payment $419.69
04/25/2024 Contractual Allowance Adjustment -$650.93
07/31/2024 Contractual Allowance Adjustment $650.93
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,338.28
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ........-$267.66
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880248} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629400
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354578 Upon Receipt $0.00 $
Page 1 of 2
FTTTFFFTADDDATDTDADFDDTATATDFFTTFTTDATAFDTADDTFDADATAFTTTTDDDATTD DFATFAFDFAFTTFDDTADDFFTDAADFADTTFFADFTDADTADTDAAADFADDTAATFDFDATF
TROY VIRGIL POWERS MORGAN MEDICAL CENTER
1530 FAIRPLAY RD PO BOX 860
RUTLEDGE GA 30663-2321 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354578 TROY VIRGIL POWERS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (04/02/24 - 04/03/24) TROY V POWERS
Provider: Werkin, Jacob MD
04/02/2024 PHARMACY $108.00
04/02/2024 IV SOLUTIONS $88.04
04/02/2024 MED-SUR SUPPLIES $41.84
04/02/2024 STERILE SUPPLY $367.50
04/02/2024 LABORATORY $5.00
04/02/2024 LAB/HEMATOLOGY $128.00
04/02/2024 OR SERVICES $2,254.00
04/02/2024 ANESTHESIA $978.00
04/02/2024 DRUGS/DETAIL CODE $125.60
04/02/2024 RECOVERY ROOM $1,194.00
04/02/2024 OBSERVATION RM $1,379.00
04/02/2024 PRO FEE/ANES CRNA $1,467.00
04/02/2024 PRO FEE/OR $683.25
04/02/2024 PRO FEE/HOS VIS $463.24
04/03/2024 PHARMACY $12.00
04/03/2024 IV SOLUTIONS $92.02
04/03/2024 STERILE SUPPLY $32.56
04/03/2024 LAB/HEMATOLOGY $90.00
04/03/2024 LAB/OTHER $314.00
04/03/2024 BLOOD/STOR-PROC $422.00
04/03/2024 BLOOD/ADMIN $677.00
04/03/2024 DRUGS/DETAIL CODE $5,382.00
04/03/2024 OBSERVATION RM $1,379.00
04/03/2024 PRO FEE/HOS VIS $211.26
04/08/2024 LAB/HEMATOLOGY $64.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$17,958.31
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ...-$13,716.40
1-888-618-1683. Patient Payments/Adjustments: ..........-$2,710.91
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880248}
Page 2 of 2
STATEMENT NUMBER STATEMENT DATE
300354578 08/07/2024
DUE DATE AMOUNT DUE
PATIENT STATEMENT Upon Receipt $0.00
For billing questions, please call: ACCOUNT NAME
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm TROY VIRGIL POWERS
Payments/ Patient
Date Service Description Charges
Adjustments Balance
07/31/2024 Medicare payment -$5,022.74
08/05/2024 Commercial insurance payment -$2,710.91
07/31/2024 Contractual Allowance Adjustment -$8,693.66
Patient Balance -$2,710.91
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
APD{3120880263} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629477
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354577 Upon Receipt $0.00 $
Page 1 of 1
TFATTATTDFTFDTFDFDTFAAFTAADDFDATTDFTDDTAFATAADDAAFDATATFDFFDTFFFD FDDDADAADAAFDFFAATFTDADTDAFTDFFTDTFAADDTFTDADAFDTDTFFDDFTAADATFAD
FRANK O WALSH III MORGAN MEDICAL CENTER
651 DIXIE AVE PO BOX 860
MADISON GA 30650-1801 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354577 FRANK O WALSH III 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/24/24) FRANK O WALSH
Provider: Socoloff, David Neal DO
07/24/2024 PHARMACY $24.00
07/24/2024 NON-STER SUPPLY $31.48
07/24/2024 STERILE SUPPLY $31.92
07/24/2024 PATHOL/HYSTOL $138.00
07/24/2024 OR SERVICES $4,005.00
07/24/2024 ANESTHESIA $1,345.96
07/24/2024 DRUGS/DETAIL CODE $105.60
07/24/2024 RECOVERY ROOM $1,194.00
07/24/2024 PRO FEE/ANES CRNA $1,467.00
07/30/2024 Contractual Allowance Adjustment -$24.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$8,342.96
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ..........-$24.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880282} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7907716566
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354575 Upon Receipt $1,316.13 $
Page 1 of 1
DFTATAFDATADDFTFDTTDFTAAATTTDDDDFDAADAATFTFTTADFFTAFDDTAADDADDDDT FFFAAAFATAFDDDFFDTDTAADDTTFDFDDTTDAFTDDAFDDDTAAFFDDATDDAAFTDADADD
FELICIA ANN NELSON MORGAN MEDICAL CENTER
1000 PINE TREE CIR LOT 96 PO BOX 860
MADISON GA 30650-4769 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354575 FELICIA ANN NELSON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (04/03/24) FELICIA A NELSON
Provider: Spencer, Dennis DO
Patient Balance $1,316.13
MESSAGES
We have not received payment. Please pay the current balance by the due date
shown. For questions regarding your bill, please contact our Billing office at Total Charges: .....................................$2,309.00
1-888-618-1683. Insurance Payments/Adjustments:..............$0.00
Patient Payments/Adjustments: .............-$992.87
PENDING BALANCE: $1,316.13
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880301} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7944455034
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354573 Upon Receipt $0.00 $
Page 1 of 1
DTFTAFFTADFTTDDATTFADTTFAFFFFATFTTTFDAFATATFFTDTFDAFFDAFTFDFTTADT DDTFFDADAAAATDDTFAFDTFTTFTDATFATAAFTDTDTDDAADDFDDDAFTDTFTTDDFTDFF
TRAMPUS L SHELNUTT MORGAN MEDICAL CENTER
1000 HODGES AVE PO BOX 860
MADISON GA 30650-2042 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354573 TRAMPUS L SHELNUTT 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (09/25/23) TRAMPUS L SHELNUTT
Provider: Johnson, Savannah BSN RN
09/25/2023 CLINIC $115.00
09/25/2023 OTHER CLINIC $480.00
09/25/2023 PRO FEE/OUTPT $67.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$662.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880316} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629470
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354572 Upon Receipt $0.00 $
Page 1 of 1
AAFADDAFTTATDFATDATFDDAADDTFDFTTAAADAFTDFTTADFADTFATTTTDAADTFTTTA DTDTDFTFFFDAFFTTADDFDDFTAFDDTATADADDFTADTAATDDTDTFFDFATTDDFFFADTA
BETTY VANNIER MORGAN MEDICAL CENTER
225 MEADOWS RD PO BOX 860
COVINGTON GA 30014-1079 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354572 BETTY VANNIER 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (10/02/23) BETTY VANNIER
Provider: Werkin, Jacob MD
10/02/2023 CLINIC $115.00
10/02/2023 PRO FEE/OUTPT $149.00
10/02/2023 PRO FEE/CLINIC $505.41
11/30/2023 Medicare payment -$37.19
12/06/2023 Commercial insurance payment -$23.00
11/30/2023 Contractual Allowance Adjustment -$203.81
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$769.41
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ........-$264.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880334} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8032710507
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354571 Upon Receipt $0.00 $
Page 1 of 1
DTAATFFDATAAADDTAAATTTFAAFTTTAFFTTDADTFFADAFFDFDDDATATFTTAADDTDTF FAADTTDTDFTDAFAFTFFAFTADDFFAFTFAFDTAADAFAADFTADAAFTTDADDFFAFAFTAT
VICKI H COGGINS MORGAN MEDICAL CENTER
474 FOSTER ST PO BOX 860
MADISON GA 30650-1606 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354571 VICKI H COGGINS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (04/09/24) VICKI H COGGINS
Provider: BASHIR, MUHAMMAD H MD
04/09/2024 LABORATORY $403.00
04/09/2024 LAB/UROLOGY $6.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$409.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880348} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629113
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354568 Upon Receipt $0.00 $
Page 1 of 1
FATFFAFDTTFATTTDFDDTTDTFTAADDFDAAATTTDFFAAFDDTATATFTTATTFFADFAADT TATFTTTDTDTFTTTFFFAFATAAFDAATTFFAFDADFATTFDAAFDADAAFAAFFDTTADFDFT
LAURA A PITTMAN MORGAN MEDICAL CENTER
104 SAMMONS RD PO BOX 860
EATONTON GA 31024-6200 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354568 LAURA A PITTMAN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/05/23) LAURA A PITTMAN
Provider: Chhabra, Anil Kumar MD
08/05/2023 PHARMACY $24.00
08/05/2023 DX X-RAY $892.00
08/05/2023 EMERG ROOM $1,943.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$2,859.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880363} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629469
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354565 Upon Receipt $0.00 $
Page 1 of 1
AAAAFAAFDTFAAAFFFDAFAAADAADFFTADTDAADDDFFTDFATTATFFDFFTDTAFFDFADT ATFADFDAADDTDTATDDTATDAFTDTFFATFATTDTFAAAFADFTTDFADATAAAFADATATDA
TRINEKKA MILLER MORGAN MEDICAL CENTER
1030 CHARITY DR PO BOX 860
GREENSBORO GA 30642-2779 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354565 TRINEKKA MILLER 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (09/21/23) TRINEKKA MILLER
Provider: Brown, Kirk Tahama MD
09/21/2023 DX X-RAY $506.00
09/21/2023 EMERG ROOM $1,943.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$2,449.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880379} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8183324508
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354564 Upon Receipt $0.00 $
Page 1 of 1
AAFFFAFAFDAADAADFAAFADFFTDDAADDATDTDAAFAAAFAAFDADDAFTTFFTFFDFDTFD ADADFDFTFTATAAFTTAATDFDFDATTFFADDTATAADFFTTFFTFDATTTDDADAFFTTTAAF
SHEILA WHALEY MORGAN MEDICAL CENTER
649 SKYLINE DR PO BOX 860
MADISON GA 30650-1973 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354564 SHEILA WHALEY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (10/26/23) SHEILA WHALEY
Provider: Pepper, Robert Thomas MD
10/26/2023 CLINIC $115.00
10/26/2023 PRO FEE/CLINIC $221.52
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$336.52
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880393} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7928729621
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354562 Upon Receipt $0.00 $
Page 1 of 1
FDAFDFDAFDDFTFTAAFFADFFTTFFTFAATTAAFAADAFFTFFATTDFAAFFTFFTAAATADT TFDTAAAFDTFFFADFATTDFATAAAAFTDDDFFFFFFDDDTFTAFAATTFDDDFTTDATDDDTD
EMILY C JACKSON MORGAN MEDICAL CENTER
1561 BOSTWICK HWY PO BOX 860
MADISON GA 30650-3661 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354562 EMILY C JACKSON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/28/23) EMILY C JACKSON
Provider: Stephenson, Cynthia DO
07/28/2023 PHARMACY $12.00
07/28/2023 DX X-RAY $587.00
07/28/2023 DX X-RAY/CHEST $173.00
07/28/2023 CT SCAN/HEAD $1,545.00
07/28/2023 CT SCAN/BODY $1,224.00
07/28/2023 EMERG ROOM $2,131.00
07/28/2023 DRUGS/DETAIL CODE $24.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$5,696.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880410} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7957777078
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354561 Upon Receipt $0.00 $
Page 1 of 1
FFFDTTDTTTTAFAFDTFATATAADFTFTTATADAFFTFFTTFAATFADAFTAFADFATAAFAFD DFDDDTAFFFAAFFTDATFFFFATFADATTATFFDTFDTDDAAATDDATDADDTTDTTFFFDFAA
JANICE C PHILIPPI MORGAN MEDICAL CENTER
1251 PORTER RD PO BOX 860
BUCKHEAD GA 30625-1704 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354561 JANICE C PHILIPPI 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/24/23) JANICE C PHILIPPI
Provider: Wojciechowski, Tamara CRNA
08/24/2023 PHARMACY $48.00
08/24/2023 STERILE SUPPLY $5.00
08/24/2023 OR SERVICES $2,227.00
08/24/2023 DRUGS/DETAIL CODE $50.30
08/24/2023 Patient payment -$275.00
09/07/2023 Medicare payment -$192.21
09/07/2023 Contractual Allowance Adjustment -$367.09
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$2,330.30
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ........-$559.30
1-888-618-1683. Patient Payments/Adjustments: .............-$275.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880423} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629463
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354560 Upon Receipt $0.00 $
Page 1 of 4
DFDAATATFTTATFAFATTTFATFADFTTTTFTFDAFTAAADTAAFDFDDAAAFAADDATDDATT FDATTFFTDFFDAFAATADADAFDTAFDFADTDTTFATTFFAFDDATTADDTDTDTAFAFATATT
HUGH H MORGAN MORGAN MEDICAL CENTER
1660 JENNINGS MILL RD APT 144 PO BOX 860
WATKINSVILLE GA 30677-7294 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354560 HUGH H MORGAN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/23/23 - 09/18/23) HUGH H MORGAN
Provider: Beharrysingh, Rudra MD
08/23/2023 MED-SUR-GY/PVT $1,654.00
08/23/2023 PHARMACY $65.47
08/23/2023 NON-STER SUPPLY $34.00
08/23/2023 STERILE SUPPLY $27.00
08/23/2023 LAB/BACT-MICRO $46.00
08/23/2023 LAB/UROLOGY $36.00
08/24/2023 MED-SUR-GY/PVT $1,654.00
08/24/2023 PHARMACY $385.32
08/24/2023 LABORATORY $146.00
08/24/2023 LAB/CHEMISTRY $129.00
08/24/2023 LAB/HEMATOLOGY $164.00
08/24/2023 PHYSICAL THERAPY $88.00
08/24/2023 PHYS THERP/EVAL $190.00
08/24/2023 OCCUP THERP/EVAL $203.00
08/25/2023 MED-SUR-GY/PVT $1,654.00
08/25/2023 PHARMACY $290.32
08/25/2023 LAB/CHEMISTRY $123.00
08/25/2023 DX X-RAY/CHEST $171.00
08/25/2023 PHYSICAL THERAPY $244.00
08/25/2023 OCCUPATION THER $122.00
08/26/2023 MED-SUR-GY/PVT $1,654.00
08/26/2023 PHARMACY $548.58
08/27/2023 MED-SUR-GY/PVT $1,654.00
08/27/2023 PHARMACY $331.04
08/28/2023 MED-SUR-GY/PVT $1,654.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$69,609.99
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ...-$69,609.98
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880423}
Page 2 of 4
STATEMENT NUMBER STATEMENT DATE
300354560 08/07/2024
DUE DATE AMOUNT DUE
PATIENT STATEMENT Upon Receipt $0.00
For billing questions, please call: ACCOUNT NAME
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm HUGH H MORGAN
Payments/ Patient
Date Service Description Charges
Adjustments Balance
08/28/2023 PHARMACY $411.78
08/28/2023 PHYSICAL THERAPY $298.00
08/28/2023 OCCUPATION THER $183.00
08/29/2023 MED-SUR-GY/PVT $1,654.00
08/29/2023 PHARMACY $460.57
08/29/2023 LAB/BACT-MICRO $6.00
08/29/2023 PHYSICAL THERAPY $380.00
08/29/2023 OCCUPATION THER $199.00
08/30/2023 MED-SUR-GY/PVT $1,654.00
08/30/2023 PHARMACY $530.10
08/30/2023 LAB/CHEMISTRY $87.00
08/30/2023 LAB/IMMUNOLOGY $17.00
08/30/2023 LAB/HEMATOLOGY $64.00
08/30/2023 DX X-RAY/CHEST $171.00
08/30/2023 PHYSICAL THERAPY $353.00
08/30/2023 OCCUPATION THER $271.00
08/31/2023 MED-SUR-GY/PVT $1,654.00
08/31/2023 PHARMACY $636.48
08/31/2023 LAB/CHEMISTRY $191.00
08/31/2023 LAB/HEMATOLOGY $64.00
08/31/2023 PHYSICAL THERAPY $353.00
08/31/2023 OCCUPATION THER $303.00
09/01/2023 MED-SUR-GY/PVT $1,654.00
09/01/2023 PHARMACY $550.56
09/01/2023 PHYSICAL THERAPY $204.00
09/01/2023 PHYS THERP/GROUP $112.00
09/01/2023 OCCUPATION THER $200.00
09/02/2023 MED-SUR-GY/PVT $1,654.00
09/02/2023 PHARMACY $490.56
09/02/2023 LAB/CHEMISTRY $191.00
09/02/2023 LAB/IMMUNOLOGY $17.00
09/02/2023 LAB/HEMATOLOGY $64.00
09/03/2023 MED-SUR-GY/PVT $1,654.00
09/03/2023 PHARMACY $557.52
09/03/2023 NON-STER SUPPLY $8.00
09/03/2023 LAB/CHEMISTRY $19.00
09/04/2023 MED-SUR-GY/PVT $1,654.00
09/04/2023 PHARMACY $498.51
09/04/2023 RESPIRATORY SVC $6.00
09/04/2023 PHYSICAL THERAPY $292.00
09/04/2023 OCCUPATION THER $183.00
09/04/2023 SPEECH PATHOL $177.00
09/04/2023 SPEECH PATH/EVAL $440.00
09/05/2023 MED-SUR-GY/PVT $1,654.00
09/05/2023 PHARMACY $430.56
09/05/2023 PHYSICAL THERAPY $347.00
09/05/2023 OCCUPATION THER $210.00
09/05/2023 SPEECH PATHOL $177.00
09/06/2023 MED-SUR-GY/PVT $1,654.00
09/06/2023 PHARMACY $2,385.64
09/06/2023 LAB/CHEMISTRY $87.00
09/06/2023 LAB/HEMATOLOGY $64.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
APD{3120880423}
Page 3 of 4
STATEMENT NUMBER STATEMENT DATE
300354560 08/07/2024
DUE DATE AMOUNT DUE
PATIENT STATEMENT Upon Receipt $0.00
For billing questions, please call: ACCOUNT NAME
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm HUGH H MORGAN
Payments/ Patient
Date Service Description Charges
Adjustments Balance
09/06/2023 PHYSICAL THERAPY $320.00
09/06/2023 OCCUPATION THER $183.00
09/06/2023 SPEECH PATHOL $177.00
09/07/2023 MED-SUR-GY/PVT $1,654.00
09/07/2023 PHARMACY $410.10
09/07/2023 LAB/CHEMISTRY $87.00
09/07/2023 LAB/HEMATOLOGY $64.00
09/07/2023 PHYSICAL THERAPY $353.00
09/07/2023 OCCUPATION THER $210.00
09/07/2023 SPEECH PATHOL $177.00
09/08/2023 MED-SUR-GY/PVT $1,654.00
09/08/2023 PHARMACY $398.10
09/08/2023 LAB/CHEMISTRY $19.00
09/08/2023 PHYSICAL THERAPY $143.00
09/08/2023 PHYS THERP/GROUP $112.00
09/08/2023 OCCUPATION THER $189.00
09/09/2023 MED-SUR-GY/PVT $1,654.00
09/09/2023 PHARMACY $374.10
09/09/2023 PHYSICAL THERAPY $116.00
09/09/2023 SPEECH PATHOL $177.00
09/10/2023 MED-SUR-GY/PVT $1,654.00
09/10/2023 PHARMACY $398.10
09/11/2023 MED-SUR-GY/PVT $1,654.00
09/11/2023 PHARMACY $542.10
09/11/2023 PHYSICAL THERAPY $408.00
09/11/2023 OCCUPATION THER $183.00
09/11/2023 SPEECH PATHOL $177.00
09/12/2023 MED-SUR-GY/PVT $1,654.00
09/12/2023 PHARMACY $634.98
09/12/2023 LAB/CHEMISTRY $19.00
09/12/2023 LAB/HEMATOLOGY $64.00
09/12/2023 PHYSICAL THERAPY $408.00
09/12/2023 OCCUPATION THER $210.00
09/12/2023 SPEECH PATHOL $177.00
09/13/2023 MED-SUR-GY/PVT $1,654.00
09/13/2023 PHARMACY $398.10
09/13/2023 PHYSICAL THERAPY $259.00
09/13/2023 OCCUPATION THER $210.00
09/13/2023 SPEECH PATHOL $177.00
09/14/2023 MED-SUR-GY/PVT $1,654.00
09/14/2023 PHARMACY $458.10
09/14/2023 LAB/CHEMISTRY $87.00
09/14/2023 LAB/HEMATOLOGY $64.00
09/14/2023 PHYSICAL THERAPY $292.00
09/14/2023 OCCUPATION THER $210.00
09/15/2023 MED-SUR-GY/PVT $1,654.00
09/15/2023 PHARMACY $470.10
09/16/2023 MED-SUR-GY/PVT $1,654.00
09/16/2023 PHARMACY $466.05
09/17/2023 MED-SUR-GY/PVT $1,654.00
09/17/2023 PHARMACY $446.10
09/18/2023 PHARMACY $271.05
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
APD{3120880423}
Page 4 of 4
STATEMENT NUMBER STATEMENT DATE
300354560 08/07/2024
DUE DATE AMOUNT DUE
PATIENT STATEMENT Upon Receipt $0.00
For billing questions, please call: ACCOUNT NAME
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm HUGH H MORGAN
Payments/ Patient
Date Service Description Charges
Adjustments Balance
09/18/2023 STERILE SUPPLY $27.00
09/18/2023 RESPIRATORY SVC $6.00
10/16/2023 Medicare payment -$55,795.06
10/27/2023 Commercial insurance payment -$1,176.00
05/17/2024 Medicare payment -$7,427.94
07/13/2024 Medicare payment $7,427.95
10/16/2023 Contractual Allowance Adjustment -$12,638.93
05/17/2024 Contractual Allowance Adjustment -$5,210.99
07/13/2024 Contractual Allowance Adjustment $0.00
07/17/2024 Contractual Allowance Adjustment $5,210.99
Patient Balance $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
APD{3120880440} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8097346015
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354558 Upon Receipt $0.00 $
Page 1 of 1
TAFAFTDDTATDDADDDAADTFFAADTTFFDFDADFTTTFFTFFDFTDDFTTFDDDAFADTTDFT FTFFADDATATDDDFADDFTTTTDDDFAFFFAATAATDFAADDFDAFDFFTATFDFFFTDAATFD
PEGGY J HENLEY MORGAN MEDICAL CENTER
109 S SPRING RD PO BOX 860
EATONTON GA 31024-8176 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354558 PEGGY J HENLEY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (04/12/24) PEGGY J HENLEY
Provider: Cannington, Sara Danielle FNP
04/12/2024 IV THERAPY $558.00
04/12/2024 NON-STER SUPPLY $31.48
04/12/2024 STERILE SUPPLY $23.28
04/12/2024 CLINIC $130.00
04/12/2024 DRUGS/DETAIL CODE $24.00
04/25/2024 Contractual Allowance Adjustment -$376.90
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$766.76
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ........-$376.90
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880454} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629465
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354557 Upon Receipt $0.00 $
Page 1 of 1
ADFFFFDAAFTFDTDAFFAFTTTADFFFFFFDFATDDFFTTTTADAATAATFFFFAFTTDAATTT DATAFATDAADATDDDFFDDADDTADDDTDTATFFDDTFTTDATTDAADFFFAFTADDDDFFDDF
AMY DARNELL MORGAN MEDICAL CENTER
1440 APALACHEE WOODS TRL PO BOX 860
BUCKHEAD GA 30625-1538 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354557 AMY DARNELL 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/25/23) COLT J DARNELL
Provider: SMITH, LARRY R
08/25/2023 LABORATORY $64.00
08/25/2023 LAB/CHEMISTRY $78.00
08/25/2023 LAB/HEMATOLOGY $64.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$206.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880472} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7947560545
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354556 Upon Receipt $0.00 $
Page 1 of 1
TDAFAFATDDAFATTAATAFTTFDTTFFAFDADTTDATFDTAFTDADDATATDDTDADDDTTDAA AAATFADTFTDTAAFDTFTTFDDFTFTDFDTFDDADAAFFATADATAFAADTDFATFAFTTFATF
WILLIAM B BARKER MORGAN MEDICAL CENTER
1081 WHISPERING LAKES TRL PO BOX 860
MADISON GA 30650-6325 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354556 WILLIAM B BARKER 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (10/21/23) WILLIAM B BARKER
Provider: Chhabra, Anil Kumar MD
10/21/2023 PHARMACY $12.00
10/21/2023 LABORATORY $193.00
10/21/2023 LAB/HEMATOLOGY $64.00
10/21/2023 EMERG ROOM $1,628.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$1,897.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880487} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8160396672
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354555 Upon Receipt $0.00 $
Page 1 of 1
FATAAFFADTDTDFFAAATDTTTFTFATDFDTDTADTTAFTDDDFFDTFTADDADTAFDAFAAAA TTDDADTFDTTFFADAADADDTTAFFAATFFFFAFAFFFDTTDAFFFTTAADFFFDDTATDAFAD
JONATHAN WHITE MORGAN MEDICAL CENTER
428 LAKEWOOD DR PO BOX 860
SOCIAL CIRCLE GA 30025-2940 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354555 JONATHAN WHITE 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (10/06/23) JONATHAN WHITE
Provider: Chhabra, Anil Kumar MD
10/06/2023 DX X-RAY $978.00
10/06/2023 EMERG ROOM $1,943.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$2,921.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880499} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629462
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354553 Upon Receipt $0.00 $
Page 1 of 1
DFDTATFFDTFTDFTDFTFFFTTTAADFDDAFFDFDFTAATTDTAFTFADAFFTDAADDAFDDTA TDTATFADTDFFTTTAFATFTAFAATADTADDTADFDATTDFFTFFTDDTFFATFATTTADTDDT
JOSEPH SOJKA MORGAN MEDICAL CENTER
3540 ENTERPRISE RD PO BOX 860
MADISON GA 30650-5676 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354553 JOSEPH SOJKA 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (08/27/23) JOSEPH SOJKA
08/27/2023 PHARMACY $12.00
08/27/2023 DX X-RAY $257.00
08/27/2023 CT SCAN/HEAD $1,545.00
08/27/2023 CT SCAN/BODY $2,564.00
08/27/2023 EMERG ROOM $1,943.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$6,321.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880517} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8096843032
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354552 Upon Receipt $0.00 $
Page 1 of 1
DTADATADTFAFTDFAFFDTFDTDFATDFAFDAATTDFADTDATTATADADDATDTAADFFDDTF AFFFDTFAADATDTADDTAAAFAFDTTAFTADADTTTATAFFAFATDFFTTAATAFAADATDTFA
JACOB R PITTMAN MORGAN MEDICAL CENTER
195 MARSHALL RD NE PO BOX 860
MILLEDGEVILLE GA 31061-9096 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354552 JACOB R PITTMAN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/03/24) JACOB R PITTMAN
Provider: Pepper, Robert Thomas MD
06/03/2024 LABORATORY $5.00
06/03/2024 LAB/CHEMISTRY $65.75
06/03/2024 PRO FEE/OUTPT $306.15
06/03/2024 Patient payment -$15.00
Patient Balance -$15.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$376.90
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$15.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880531} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629461
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354551 Upon Receipt $0.00 $
Page 1 of 1
FDTTDDDFDFTADTTDDDDAAAAAFDDTFDTADADAATFFADDFTDFDDTFTFFFAFTTFATFFA FAFDFTDAFATTDFFDTDFTFDTDDFDAFDAAFDATATFAATAFTTFFAFTADFTFFFFDAFTAF
CAROLYN MICHAEL MORGAN MEDICAL CENTER
8091 GA HIGHWAY 15 PO BOX 860
SPARTA GA 31087-3569 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354551 CAROLYN MICHAEL 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (05/29/24) CAROLYN MICHAEL
Provider: Brown, Kirk Tahama MD
05/29/2024 PHARMACY $12.00
05/29/2024 DRUGS/INCIDENT RAD $500.00
05/29/2024 LABORATORY $146.00
05/29/2024 LAB/HEMATOLOGY $64.00
05/29/2024 CT SCAN/HEAD $1,545.00
05/29/2024 CT SCAN/BODY $4,170.00
05/29/2024 EMERG ROOM $1,943.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$8,380.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880545} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7937443535
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354550 Upon Receipt $0.00 $
Page 1 of 1
DDADDDDAAFTDFATADFAADADTDFDFTADDAADFAFTFDFAAFDATTADDDFFDDTADTTTTA DTTTAFTDDADFTFDAAFDDDTDTAFFDTFDADAFFFDFTTTDTDFATTFFFFFDADDADFADTD
KIM D CROTTS MORGAN MEDICAL CENTER
2340 DIXIE HWY PO BOX 860
MADISON GA 30650-3520 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354550 KIM D CROTTS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/13/24) KIM D CROTTS
Provider: Werkin, Jacob MD
06/13/2024 PHARMACY $109.39
06/13/2024 MED-SUR SUPPLIES $41.84
06/13/2024 NON-STER SUPPLY $88.48
06/13/2024 STERILE SUPPLY $232.04
06/13/2024 OR SERVICES $14,367.00
06/13/2024 ANESTHESIA $2,067.01
06/13/2024 DRUGS/DETAIL CODE $222.09
06/13/2024 RECOVERY ROOM $1,194.00
06/13/2024 PRO FEE/ANES CRNA $1,467.06
06/13/2024 PRO FEE/OR $1,287.72
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$21,076.63
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880557} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8141811779
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354548 Upon Receipt $0.00 $
Page 1 of 1
FFDDFTTAAFDATTFDAFDAAFAFFAFDADFAADTTTADTFAFDATFFAFTFAFAFTDFFFFDAA DDDFTDAFTFAFFDTAFTFFTAATFTFATAFTAADADTTDDFFADFDTDDADATDDTDTFFTDFT
TAMMY A HIGGINS MORGAN MEDICAL CENTER
597 PHILLIPS DR PO BOX 860
MONROE GA 30656-4165 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354548 TAMMY A HIGGINS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/15/24) TAMMY A HIGGINS
Provider: Cannington, Sara Danielle FNP
07/15/2024 PRO FEE/OUTPT $390.08
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$390.08
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880569} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8102979510
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354547 Upon Receipt $0.00 $
Page 1 of 2
FDATDDFTDAAFDTTAFAADTDFADTDTAFFDTAATDTATFFDFDFADTTFFTDAAATFFFTADD FFAADAFTAFFTADADDADAAFFDTTDDFTTTTDTDTDTFFFTDTTTFFDDTTTTTAFDFADTDA
MARGARET H DUNN MORGAN MEDICAL CENTER
1600 BETHANY RD UNIT 2007 PO BOX 860
MADISON GA 30650-4778 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354547 MARGARET H DUNN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/04/24 - 06/30/24) MARGARET H DUNN
Provider: TOWNSEND, DAVID L
06/04/2024 PHYSICAL THERAPY $88.00
06/04/2024 PHYS THERP/EVAL $190.00
06/13/2024 PHYSICAL THERAPY $264.00
06/20/2024 IV SOLUTIONS $30.06
06/20/2024 NON-STER SUPPLY $31.48
06/20/2024 STERILE SUPPLY $23.28
06/20/2024 PHYSICAL THERAPY $255.00
06/20/2024 CLINIC $698.00
06/20/2024 DRUGS/DETAIL CODE $88.00
06/21/2024 IV SOLUTIONS $30.06
06/21/2024 NON-STER SUPPLY $31.48
06/21/2024 STERILE SUPPLY $30.28
06/21/2024 CLINIC $698.00
06/21/2024 DRUGS/DETAIL CODE $88.00
06/22/2024 IV SOLUTIONS $30.06
06/22/2024 IV THERAPY $568.00
06/22/2024 STERILE SUPPLY $19.16
06/22/2024 CLINIC $130.00
06/22/2024 DRUGS/DETAIL CODE $88.00
06/23/2024 IV SOLUTIONS $30.06
06/23/2024 IV THERAPY $568.00
06/23/2024 STERILE SUPPLY $19.16
06/23/2024 CLINIC $130.00
06/23/2024 DRUGS/DETAIL CODE $88.00
06/24/2024 IV SOLUTIONS $30.06
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$5,614.90
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: .....-$1,325.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880569}
Page 2 of 2
STATEMENT NUMBER STATEMENT DATE
300354547 08/07/2024
DUE DATE AMOUNT DUE
PATIENT STATEMENT Upon Receipt $0.00
For billing questions, please call: ACCOUNT NAME
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm MARGARET H DUNN
Payments/ Patient
Date Service Description Charges
Adjustments Balance
06/24/2024 NON-STER SUPPLY $31.48
06/24/2024 STERILE SUPPLY $23.28
06/24/2024 CLINIC $698.00
06/24/2024 DRUGS/DETAIL CODE $88.00
06/25/2024 PHYSICAL THERAPY $264.00
06/27/2024 PHYSICAL THERAPY $264.00
07/25/2024 Medicare payment -$662.27
07/25/2024 Contractual Allowance Adjustment -$662.73
Patient Balance $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
APD{3120880588} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629167
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354545 Upon Receipt $0.00 $
Page 1 of 1
TTDTDFFFFTAFDFATFTDATTFTFTFTDATAFADFFAFATDDDFDDTDTDAATTAADDADAFDF TFTTDAADFDFATATDAATFFFFAAATDTTTDDFDDFFTTDATTADTFTTFFFTAATTFADDDTA
EUGENE D BUTT MORGAN MEDICAL CENTER
1041 GREENWOOD CIR PO BOX 860
MADISON GA 30650-3782 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354545 EUGENE D BUTT 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (06/01/24 - 06/30/24) EUGENE D BUTT
Provider: POLING, JON
06/03/2024 PHYSICAL THERAPY $237.00
06/05/2024 PHYSICAL THERAPY $176.00
06/10/2024 PHYSICAL THERAPY $237.00
06/11/2024 OCCUPATION THER $244.00
06/13/2024 OCCUPATION THER $366.00
06/14/2024 PHYSICAL THERAPY $300.00
06/18/2024 OCCUPATION THER $366.00
06/25/2024 OCCUPATION THER $366.00
06/27/2024 PHYSICAL THERAPY $219.00
07/19/2024 Medicare payment -$787.45
07/19/2024 Contractual Allowance Adjustment -$1,221.35
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$2,511.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: .....-$2,008.80
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880605} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8110436208
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354544 Upon Receipt $0.00 $
Page 1 of 1
AAADFTDFAFTTDAAFFAADAFFATDATTTDAAFDTDAFATTFDAAAAFFFAAATFDFATTFDFT ADFDTDFADDADDAAATTAADAAFDAAAFAFDFTTAAATAFADFFADDATTAFTFFAFAATTTAT
KEITH B BRAND MORGAN MEDICAL CENTER
1520 NOLAN STORE RD PO BOX 860
MADISON GA 30650-2895 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354544 KEITH B BRAND 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/19/24) KEITH B BRAND
Provider: Cannington, Sara Danielle FNP
07/19/2024 LABORATORY $374.00
07/19/2024 LAB/BACT-MICRO $150.00
07/19/2024 PRO FEE/CLINIC $258.19
07/19/2024 Patient payment -$35.00
Patient Balance -$35.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$782.19
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$35.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880622} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8089092247
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354541 Upon Receipt $0.00 $
Page 1 of 1
TADFAATATATADDAFFFTTFFDTTDTAATAFTDDAATDAATATTDFAFFAFTFTFFDDTFFTTF ATAAAFDTTTDDATFADFTTTTDFTDADFFDFTTAFTFFFADFDFAATFADTTFFTFFTTTATDD
BETTY J STEWART MORGAN MEDICAL CENTER
1170 SULGRAVE DR PO BOX 860
MADISON GA 30650-4614 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354541 BETTY J STEWART 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (01/10/24) BETTY J STEWART
Provider: Pepper, Robert Thomas MD
01/10/2024 LAB/CHEMISTRY $100.00
01/10/2024 CLINIC $135.00
01/10/2024 PRO FEE/CLINIC $176.15
03/13/2024 Medicare payment -$49.97
03/13/2024 Contractual Allowance Adjustment -$50.03
06/26/2024 Contractual Allowance Adjustment -$5.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$411.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments: ........-$105.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880640} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8042851150
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354539 Upon Receipt $0.00 $
Page 1 of 1
ATADATTATDFFFDFDDTTDAADDFADFTDTAAFDFTDFAFFFFTADFAFTADAAFFADFDDTDD TADFFTTFATTAFTDDFDADADTAFDTATDAFAFFTDAFDTDTAADFFDAADTFADDDDTDFFFF
ROBERT E MAHOOD MORGAN MEDICAL CENTER
2101 BROUGHTON RD PO BOX 860
NEWBORN GA 30056-2546 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354539 ROBERT E MAHOOD 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/17/24) ROBERT E MAHOOD
Provider: Pepper, Robert Thomas MD
07/17/2024 LABORATORY $151.00
07/17/2024 LAB/CHEMISTRY $91.00
07/17/2024 LAB/HEMATOLOGY $64.00
07/17/2024 LAB/UROLOGY $6.00
07/17/2024 CLINIC $130.00
07/17/2024 PRO FEE/CLINIC $381.69
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$823.69
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880660} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629452
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354536 Upon Receipt $0.00 $
Page 1 of 1
FTAADDFATTFDTFDTFTFDTDAADTFTAATAFAADADFAAATFDTTTTDDADTFFADATFAFFT DADATATFTFDFFDTFFDDFATATADFFTTDAAFDFDTADTFDTTFTADFFDAADTDDTFFFFDT
DEBBIE L GOLDSTON MORGAN MEDICAL CENTER
1750 FOUR LAKES DR PO BOX 860
MADISON GA 30650-4266 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354536 DEBBIE L GOLDSTON 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/24/24) DEBBIE L GOLDSTON
Provider: Socoloff, David Neal DO
07/24/2024 PHARMACY $24.00
07/24/2024 NON-STER SUPPLY $31.48
07/24/2024 STERILE SUPPLY $31.92
07/24/2024 PATHOL/HYSTOL $138.00
07/24/2024 OR SERVICES $1,751.00
07/24/2024 ANESTHESIA $913.33
07/24/2024 DRUGS/DETAIL CODE $177.94
07/24/2024 RECOVERY ROOM $1,194.00
07/24/2024 PRO FEE/ANES CRNA $1,467.00
07/24/2024 Patient payment -$325.00
Patient Balance -$325.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$5,728.67
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: .............-$325.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880681} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7890115202
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354533 Upon Receipt $0.00 $
Page 1 of 1
TAFAATADAFAFTFTFDTDAATAFFTTTFDAAADFFTFATAFDDTADADTAFTTFAADTDAFAAF FTAFDDDTAFTTADATDFFATDFDDDDTFAAAATTTTTAFAFTFDTDTFFTTTATDFFDFAAAFA
EURIA L CHENAULT MORGAN MEDICAL CENTER
2491 ATHENS HWY PO BOX 860
MADISON GA 30650-3707 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354533 EURIA L CHENAULT 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/16/24) EURIA L CHENAULT
Provider: Brown, Kirk Tahama MD
07/16/2024 PHARMACY $84.00
07/16/2024 DRUGS/INCIDENT RAD $500.00
07/16/2024 LABORATORY $329.75
07/16/2024 LAB/CHEMISTRY $505.00
07/16/2024 LAB/HEMATOLOGY $256.00
07/16/2024 DX X-RAY/CHEST $171.00
07/16/2024 CT SCAN/BODY $1,397.00
07/16/2024 EMERG ROOM $2,369.00
07/16/2024 DRUGS/DETAIL CODE $48.00
07/16/2024 EKG/ECG $154.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$5,813.75
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880704} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8176384078
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354531 Upon Receipt $0.00 $
Page 1 of 1
FFAADADAFDTAFFDDFFATATDADAFAFDTTDDDFAFFDFADDADFFTAFTFTFDTTDFTDDAF FDFTFFFAFAFTDFFTTTDTDFTDTADFFFTTDTADADDAFTADDTADADDADDTAAFFDATTTF
SHARON L DEUSTERMAN MORGAN MEDICAL CENTER
4460 HIGHWAY 15 S PO BOX 860
GREENSBORO GA 30642-3693 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354531 SHARON L DEUSTERMAN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/17/24) SHARON L DEUSTERMAN
Provider: Cossio, Miguel Eduardo MD
07/17/2024 DX X-RAY $547.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$547.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880724} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8120284042
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354528 Upon Receipt $0.00 $
Page 1 of 1
ATTFTDFDFAFATTATADFDDFAAAATFTFFDTATFFDDTFDAADFTDTFTADFTAAFTTDADFD DFTDATADDAAFTFDFAAFDFADTFAFTTDFTFFFAFTDTDTDATFFATDAFFDDFTDADFDDAD
PUNTIPA MATHIS MORGAN MEDICAL CENTER
1540 CATO RD PO BOX 860
GREENSBORO GA 30642-3028 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354528 PUNTIPA MATHIS 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/12/24) PUNTIPA MATHIS
Provider: Werkin, Jacob MD
07/12/2024 PRO FEE/OUTPT $306.15
07/12/2024 Patient payment -$30.00
Patient Balance -$30.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$306.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ...............-$30.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880740} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7969611427
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354527 Upon Receipt $0.00 $
Page 1 of 1
TFTADAATTDFFDTDDATTAAAFTDAFDDTTTTDDFDDTAFADATTFFTTFAADDATADFTDDTA AFAFATFTTTADATFFDAATAADFDTATFDFDADAATADFFDDFAAFFFTTTTDFDAATTTDAFD
ALETHA DORSEY MORGAN MEDICAL CENTER
808 GARNETT ST PO BOX 860
MADISON GA 30650-1064 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354527 ALETHA DORSEY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/24/24) ALETHA DORSEY
Provider: Socoloff, David Neal DO
07/24/2024 NON-STER SUPPLY $31.48
07/24/2024 STERILE SUPPLY $26.92
07/24/2024 LAB/CHEMISTRY $54.00
07/24/2024 OR SERVICES $1,715.00
07/24/2024 ANESTHESIA $913.33
07/24/2024 DRUGS/DETAIL CODE $52.80
07/24/2024 RECOVERY ROOM $1,194.00
07/24/2024 PRO FEE/ANES CRNA $1,467.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$5,454.53
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880759} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629447
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354522 Upon Receipt $0.00 $
Page 1 of 1
FAFFTTAFADFFDDFDTDAFFADDDDAAATAATFADFAFATFFFADTFFATATTTFAATAADATF TDDAFFAFATFAFTDTFTTDTFTAATTFTFTDTAFDDFDDDDATFDATDTFDADATTTDTDTFDF
SHERRIE E MONTGOMERY MORGAN MEDICAL CENTER
5470 PRICE MILL RD PO BOX 860
BISHOP GA 30621-1700 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354522 SHERRIE E MONTGOMERY 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/29/24) SHERRIE E MONTGOMERY
Provider: Werkin, Jacob MD
07/29/2024 PHARMACY $99.79
07/29/2024 MED-SUR SUPPLIES $41.84
07/29/2024 NON-STER SUPPLY $62.96
07/29/2024 STERILE SUPPLY $53.84
07/29/2024 LAB/CHEMISTRY $54.00
07/29/2024 PATHOL/HYSTOL $138.00
07/29/2024 OR SERVICES $5,096.64
07/29/2024 ANESTHESIA $1,922.80
07/29/2024 DRUGS/DETAIL CODE $110.40
07/29/2024 RECOVERY ROOM $1,194.00
07/29/2024 PRO FEE/ANES CRNA $1,467.00
07/29/2024 PRO FEE/OR $670.71
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ...................................$10,911.98
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880781} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8203629446
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354518 Upon Receipt $0.00 $
Page 1 of 1
TDDDTFDADDTTFDAAFFTTTAFTFTDAAATDTTADDDFDTDTADFFTFFTTTFTDDFTFTADFD TTTDDDTDFDTATATTAFAFDDFAFFTTTAAFFADTFAATTATAFDDDTAAFFAAFDTFADADAA
KELLY C SMITH MORGAN MEDICAL CENTER
1231 FRACTION BOTTOMS RD PO BOX 860
BUCKHEAD GA 30625-2020 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354518 KELLY C SMITH 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (03/07/24) DALTON COPELAN
Provider: BARTON, SHANNON T
03/07/2024 DX X-RAY $763.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$763.00
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880794} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 8078538552
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354514 Upon Receipt $0.00 $
Page 1 of 1
AFFDFAFFFTFDATTFFADDFDDADADADTFTFDAADDFFFFTTTTDAFDTTADTDTADTFDTFT AAFTTADADDDDDAAFTDTAFTAFTFAFFTDFDDTFAFAAAADDAATFAADAFAFAFFAATFTTT
GWENDOLYN D FRANKLIN MORGAN MEDICAL CENTER
1141 CARMICHAEL DR PO BOX 860
MADISON GA 30650-4717 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354514 GWENDOLYN D FRANKLIN 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (07/23/24) GWENDOLYN D FRANKLIN
Provider: Spencer, Dennis DO
07/23/2024 NON-STER SUPPLY $31.48
07/23/2024 STERILE SUPPLY $7.76
07/23/2024 LABORATORY $146.00
07/23/2024 LAB/HEMATOLOGY $64.00
07/23/2024 CT SCAN/BODY $2,544.00
07/23/2024 EMERG ROOM $1,943.00
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: .....................................$4,736.24
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
APD{3120880805} Page 1
CER-437
PATIENT STATEMENT
Pay Online: https://mmh.paymyhealthbill.com/quickpay
For billing questions, please call: Access Code: 7915017019
1-888-618-1683
Office Hours: Mon-Fri 8 am-5pm Statement Number Due Date Amount Due Amount Paid
300354512 Upon Receipt $0.00 $
Page 1 of 1
DDDDAAADTFDFATTDTFTFFTATDTTDATFFDDDADTTATDFFTFDFDDDFTFTFAAATADFAT ATDFTDTATDTFDTAAFDAATTAADDAADAFFTTDATFATAFDAFADDDATFAAFFDATATAFFT
GAIL CRENSHAW MORGAN MEDICAL CENTER
320 LOYD RD PO BOX 860
MANSFIELD GA 30055-3207 MADISON, GA 30650-0860
Check if address/insurance changes are on back
Please detach and return top portion with payment.
Statement Number Account Name Statement Date Due Date
300354512 GAIL CRENSHAW 08/07/2024 Upon Receipt
Payments/ Patient
Date Service Description Charges
Adjustments Balance
Date of Service (03/11/24) GAIL CRENSHAW
Provider: Pepper, Robert Thomas MD
03/11/2024 LABORATORY $5.00
03/11/2024 LAB/CHEMISTRY $100.00
03/11/2024 PRO FEE/OUTPT $306.15
Patient Balance $0.00
MESSAGES
Thank you for choosing our facility as your healthcare provider. The balance
listed is pending the review of your insurance. You are currently not responsible Total Charges: ........................................$411.15
for the balance. If you have any questions, please contact our office at Insurance Payments/Adjustments:..............$0.00
1-888-618-1683. Patient Payments/Adjustments: ..................$0.00
PENDING BALANCE: $0.00
Morgan Medical Center | 1740 Lions Club Road Madison, GA 30650 | 706-342-1667
Change of Address If Paying By Credit Card, Fill Out Below
Name (Last, First, Middle Initial)
CHECK CARD USING FOR PAYMENT
CARD NUMBER EXP. DATE
Address
SIGNATURE AMOUNT PAID
City State ZIP
PRINT NAME CVV CODE
Telephone
Primary Insurance Updates Secondary Insurance Updates
Primary Insured Name Secondary Insured Name
Primary Insurance Name Effective Date Secondary Insurance Name Effective Date
Primary Insurance Street Address Secondary Insurance Street Address
City State ZIP Telephone City State ZIP Telephone
Employer Name Group Number Employer Name Group Number
Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth
Billing Policies
Thank you for choosing Morgan Medical Center for your healthcare services. We want to help you understand our
billing process and encourage you to contact us with questions or concerns that you have regarding your account.
You will receive monthly statements for services not covered by your insurance carrier.
Payments of your balance due:
Your balance due is payable today. If you wish to pay by credit or debit card, please complete the information above
and return it to our office or visit our website at morganmedical.org. You may also send payment by check or
visit our facility to pay by cash in person. Please include your Statement Number from the front of this bill with any
payments you send. If you have questions on your statement, balance due or wish to make a payment over the
phone, please contact our Customer Service staff at 1-888-618-1683. A service fee of $25 will be charged for any
returned checks.
Insurance updates:
If you have made changes to your insurance coverage, please complete the information above and return it to our
office or contact our Customer Service staff at 1-888-618-1683 to update your records.
Monthly payment plans:
If you are not able to pay your entire balance today, please contact our Customer Service staff at 1-888-618-1683 to
establish an approved payment plan that will protect your balance from collection activity.
Our Customer Service representatives are available Monday – Friday from 8:00 am – 5:00 pm.
Financial Assistance:
Morgan Medical Center has a financial assistance program for patients who meet specific financial criteria.
Information is available on our website at morganmedical.org or by contacting our financial counselor at
706-752-2226.
Itemized Bill is Available Upon Request
For Inquiries, please call:
Customer Service (888) 618-1683
Financial Assistance (706) 752-2226
Morgan Medical Center (706) 342-1667
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