APD{1374278426} Page 1

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Easy, automated phone payments at
29969 NETWORK PLACE | CHICAGO IL 60673-1299
your convenience. 800.627.3570
WVH-987

HOSPITAL/CLINIC STATEMENT
Pay Online: aspirus.org/billpay
Aspirus Hospital & Clinics myEasyMatch Code: X-45081-5779-2377
Billing Questions: (800) 627-3570
Office hours: M-F 8:00am - 4:30pm Account Number Due Date Amount Due Amount Paid
Check if changes on back! 736244 Upon Receipt $172.90 $
Addressee Page 1 of 4 Please make checks payable and remit to:
DFFDATFADDDDFFAATFTTFTATAFAAFATTTDFATDATDFDAATAADTFAAFAATTATFAFFD FTAFFFTTDDATFTFTATDATTTDDDAFTDFTFDTFTATTFFFFAADTTAATADFAATFADFTTT
TODD R HOOPER ASPIRUS INC
150 DOBSON DR APT 4 29969 NETWORK PLACE
IRON RIVER MI 49935-8200 CHICAGO IL 60673-1299

000736244 29969 000017290 1

myEasyMatch Code: X-45081-5779-2377 Please detach and return top portion with payment.
Account Number Account Name Statement Date Due Date

736244 TODD R HOOPER 01/18/2021 Upon Receipt

Payments/ Patient
Date Service Description Status Charges
Adjustments Balance

Coronavirus (COVID-19) is affecting the lives of everyone. Aspirus is committed to helping our
communities during this stressful time. If you're worried about paying your bill, please call us at
800.627.3570.

Hospital Services
Todd R Hooper
Provider: Meske, Kristen, N.P. Loc: Aspirus Iron River Hospital
Visit # 163009191 on 4/3/2019
LABORATORY $31.00
LAB/CHEMISTRY $107.00
LAB/HEMATOLOGY $101.00
10/08/2019 Uphp Medicaid Adjustment -$225.42
10/08/2019 Uphp Medicaid Payment -$13.58

Visit Balance Paid in Full $0.00

Todd R Hooper
Provider: Chen, Vincent L, M.D. Loc: Aspirus Iron River Hospital
Visit # 163019824 on 5/20/2019
LAB/CHEMISTRY $267.00
LAB/IMMUNOLOGY $125.00
08/13/2019 Uphp Medicaid Adjustment -$380.94
06/25/2019 Uphp Medicaid Payment -$11.06

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QUICK PAY jcbZkclw65IxyOOb2eGpCPcg0jcbZ
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To make a fast & secure one-time payment! AMOUNT DUE: $172.90

 Change of Address Did you know?
Name (Last, First, Middle Initial)
We accept credit card and bank account
Address payments via an online secure portal.
NO LOGIN REQUIRED!
Telephone Please go to aspirus.org/billpay

Primary Insurance Updates Secondary Insurance Updates

Primary Insured Name Telephone Secondary Insured Name Telephone

Primary Insurance Name Effective Date Secondary Insurance Name Effective Date

Primary Insurance Address Secondary Insurance Address

Employer Name Group Number Employer Name Group Number

Subscriber ID # Policyholder’s Date of Birth Subscriber ID # Policyholder’s Date of Birth

BILLING QUESTIONS - Contact us at a location listed below

Hospital/Clinic Billing (800) 627-3570 or (715) 847-2304

Payment Arrangements (866) 972-1774 or (715) 847-2008

Terms and Conditions

Please be aware that each time you receive services from the hospital Medicare
or clinic a separate visit number is created. It is possible to have We accept Medicare assignment and will submit your claims to Medicare
several accounts open at the same time. You will receive separate and your supplemental insurance. You will be responsible for any part of
bills from the physician (s) who provided you with your care while the Medicare approved amount not paid by Medicare or other insurance,
you were a patient at Aspirus. Just like your personal physician, the and for services not covered by Medicare.
Radiologist, Anesthesiologist, Pathologist, and other Professionals may
not be employees of Aspirus and you may receive a separate bill for Guarantor Policy
the consultative services. Their services were requested and used by The patient/guarantor of the account is the person who is financially
your physician. Please contact their office directly if you have questions responsible for payment. A guarantor may or may not be the policyholder
regarding their bills. of the insurance. In accordance with HIPAA privacy regulations, patients
age 18 and over will be their own guarantor and receive their own
Important Payment Information billing statement. In accordance with state law, both parents are legally
Thank you for choosing Aspirus for your health care needs. Payment responsible for the cost of medical care for children under 18 years old.
in full is requested within 25 days. For your convenience, we accept
Visa, MasterCard, and Discover. Credit/Debit Card payments may also Divorce Cases
be made on line at www.Aspirus.org. To maintain your good standing, The parent with whom the minor child resides and generally brings the
please contact a Financial Counselor if full payment cannot be made at child in for care will be considered the responsible party and will receive all
the Payment Arrangements numbers above. billing statements and letters. Any court-ordered financial arrangements
must be worked out between the parents of the children.
Billing Contact Information
Customer service representatives are available Monday through Friday. Insurance Coverage
If you receive our voicemail service, please leave your name and number If insurance information is provided, we will submit an insurance claim
and we will do our best to promptly return your call and meet your needs. before sending a statement to the guarantor. If insurance was not
Please see the phone numbers listed above for billing questions. provided at the time of service, or if the information has changed, please
call our office immediately. Remember your insurance policy is a contract
Aspirus Financial Aid Program between you and your insurance carrier and that you are ultimately
Patients who do not have the means to pay for necessary health responsible for all charges. If we are unable to resolve issues with your
care service can apply for assistance. Our Financial Counselor’s insurance, or if your claim is not processed timely, we will notify you. If
are available to review this and other options for financial assistance your insurance carrier requests information from you, please respond
with you in confidence. If you have questions regarding this program promptly. You will not receive a statement if your insurance pays in full.
please call 715-847-2137 or toll free at 1-800-283-2881, ext. 72137, or
visit www.aspirus.org/financialaid. Wisconsin or Michigan Medical Assistance
Please notify us if you have Medical Assistance or BadgerCare Plus and
Returned Check Fee if a statement is received for services covered.
A fee of $25.00 may be applied to your account for any returned checks.
APD{1374278426}

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ACCOUNT NUMBER STATEMENT DATE

736244 01/18/2021
29969 NETWORK PLACE | CHICAGO IL 60673-1299
DUE DATE AMOUNT DUE
HOSPITAL/CLINIC STATEMENT Upon Receipt $172.90
Aspirus Hospital & Clinics ACCOUNT NAME
Billing Questions: (800) 627-3570
Office hours: M-F 8:00am - 4:30pm TODD R HOOPER

Payments/ Patient
Date Service Description Status Charges
Adjustments Balance
Visit Balance Paid in Full $0.00

Todd R Hooper
Provider: Michael, John C, M.D. Loc: Aspirus Iron River Hospital
Visit # 163039951 on 8/16/2019
LABORATORY $32.00
LAB/CHEMISTRY $193.00
EMERGENCY SERVICES $615.00
EKG/ECG $173.00
PRO FEE/ER $399.00
09/25/2019 Uphp Medicaid Adjustment -$1,243.75
09/25/2019 Uphp Medicaid Payment -$168.25

Visit Balance Paid in Full $0.00

Todd R Hooper
Provider: Yard, Michael H, D.O. Loc: Aspirus Iron River Hospital
Visit # 163044647 on 9/4/2019
LABORATORY $32.00
LAB/CHEMISTRY $1,330.00
LAB/IMMUNOLOGY $134.00
LAB/HEMATOLOGY $105.00
10/09/2019 Uphp Medicaid Adjustment -$1,513.42
10/09/2019 Uphp Medicaid Payment -$87.58

Visit Balance Paid in Full $0.00

Todd R Hooper
Provider: Yard, Michael H, D.O. Loc: Aspirus Iron River Hospital
Visit # 163052047 on 10/4/2019
LABORATORY $32.00
LAB/CHEMISTRY $715.00
LAB/UROLOGY $61.00
11/08/2019 Uphp Medicaid Adjustment -$754.90
11/08/2019 Uphp Medicaid Payment -$53.10

Visit Balance Paid in Full $0.00

Todd R Hooper
Provider: Yard, Michael H, D.O. Loc: Aspirus Iron River Hospital
Visit # 163055104 on 10/21/2019
HOLTER MONT $1,161.00
12/03/2019 Uphp Medicaid Adjustment -$1,107.01
12/03/2019 Uphp Medicaid Payment -$53.99

Visit Balance Paid in Full $0.00

APD{1374278426}

Page 3 of 4

ACCOUNT NUMBER STATEMENT DATE

736244 01/18/2021
29969 NETWORK PLACE | CHICAGO IL 60673-1299
DUE DATE AMOUNT DUE
HOSPITAL/CLINIC STATEMENT Upon Receipt $172.90
Aspirus Hospital & Clinics ACCOUNT NAME
Billing Questions: (800) 627-3570
Office hours: M-F 8:00am - 4:30pm TODD R HOOPER

Payments/ Patient
Date Service Description Status Charges
Adjustments Balance

Todd R Hooper
Provider: Luce, Joshua L, M.D. Loc: Aspirus Iron River Hospital
Visit # 163059965 on 11/21/2019
CARDIOLOGY – ECHOCARDIOLOGY $2,028.00
12/26/2019 Uphp Medicaid Adjustment -$1,775.77
12/26/2019 Uphp Medicaid Payment -$252.23

Visit Balance Paid in Full $0.00

Todd R Hooper
Provider: Luce, Joshua L, M.D. Loc: Aspirus Iron River Hospital
Visit # 163060779 on 11/26/2019
STRESS TEST $998.00
01/08/2020 Uphp Medicaid Adjustment -$870.08
01/08/2020 Uphp Medicaid Payment -$127.92

Visit Balance Paid in Full $0.00

Todd R Hooper
Provider: Arenson, Naomi E, M.D. Loc: Aspirus Wausau Hospital
Visit # 17999930 on 12/17/2019
LABORATORY $125.00
LAB/CHEMISTRY $384.00
LAB/IMMUNOLOGY $2,098.00
06/24/2020 Uphp Medicaid Adjustment -$2,355.55
06/23/2020 Uphp Medicaid Payment -$251.45

Visit Balance Paid in Full $0.00

Todd R Hooper
Provider: Yard, Michael H, D.O. Loc: Aspirus Iron River Hospital
Visit # 163107839 on 6/9/2020
LABORATORY $133.00
LAB/CHEMISTRY $599.00
LAB/IMMUNOLOGY $72.00
LAB/HEMATOLOGY $159.00
LAB/UROLOGY $61.00
07/22/2020 Uphp Medicaid Adjustment -$950.86
07/22/2020 Uphp Medicaid Payment -$73.14

Visit Balance Paid in Full $0.00

Todd R Hooper
Provider: Yard, Michael H, D.O. Loc: Aspirus Iron River Hospital
Visit # 163133884 on 9/11/2020
APD{1374278426}

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ACCOUNT NUMBER STATEMENT DATE

736244 01/18/2021
29969 NETWORK PLACE | CHICAGO IL 60673-1299
DUE DATE AMOUNT DUE
HOSPITAL/CLINIC STATEMENT Upon Receipt $172.90
Aspirus Hospital & Clinics ACCOUNT NAME
Billing Questions: (800) 627-3570
Office hours: M-F 8:00am - 4:30pm TODD R HOOPER

Payments/ Patient
Date Service Description Status Charges
Adjustments Balance
LABORATORY $136.00
LAB/CHEMISTRY $460.00
LAB/HEMATOLOGY $55.00
12/11/2020 Uphp Medicaid Adjustment -$598.64
12/11/2020 Uphp Medicaid Payment -$52.36

Visit Balance Paid in Full $0.00

Todd R Hooper
Provider: Yard, Michael H, D.O. Loc: Aspirus Iron River Hospital
Visit # 163137724 on 9/23/2020
LABORATORY $136.00
LAB/CHEMISTRY $460.00
LAB/HEMATOLOGY $55.00
11/06/2020 Uphp Medicaid Adjustment -$598.64
11/06/2020 Uphp Medicaid Payment -$52.36

Visit Balance Paid in Full $0.00

Clinic Services
Todd R Hooper
Provider: Arenson, Naomi E, M.D. Loc: Aspirus Wausau Hospital
Visit # 19485749 on 1/5/2021
OFFICE/OUTPATIENT ESTABLISHED MOD MDM $266.00
30-39 MIN
01/18/2021 PATIENT ADJUSTMENT -$93.10

Visit Balance Current $172.90

Total Statement Balance: $172.90