MONTPIED » MEDICAL CENTER in the service of Professor ... .fr
Jun 2, 2009 - This hospital stay in the cardiology department, will be billed provisionally on : ... cashier at the admissions office of the « Gabriel Montpied ...
Mr. Kenneth Kiser chez Mr. Gary Kiser 34 rue du Président Wilson 6300 Clermont-Ferrand
ref. : 2009 case KISER KENNETH Case handled by : Mrs. Marie Josée Raffault tel: 04.73.75.13.94 fax: 04.73.75.11.94
ESTIMATION OF HOSPITAL CHARGES Upon your asking, and with the information concerning the case of Mr. Kenneth Kiser Born November 27, 1929 address: chez Gary Kiser, 34 rue du Président Wilson, 63100 Clermont-Ferrand received by the CHU of Clermont-Ferrand, we have planned a HOSPITALIZATION at the « GABRIEL
MONTPIED » MEDICAL CENTER in the service of Professor CASSAGNES starting June 2, 2009. This hospital stay in the cardiology department, will be billed provisionally on : ➢ ➢ ➢
for a total of 6,567.00 € Note / This estimation does not include
➔ ➔
The furnishing of special medications upon the discharge of the patient – it should be expected that there will be a surcharge for the dispensation of medications; Post-operation consultations and/or post-operation examinations.
These surcharges are the responsibility of the patient who must plan their financing and to pay them at the cashier at the admissions office of the « Gabriel Montpied » imperatively before the discharge of the establishment. The amount of this estimations are susceptible to change without notice in the case where the state of health of the patient necessitates care services over and above those provisioned from the clinical information provided at this date. The transportation costs to arrive at and to leave the hospital are not included and are payable by the patient. This present estimation was established to conform to the tariffs fixed by the charter of the Director of the ARH. These tariffs can change without notice in the case of the publication of a new tariff charter.
Conforming to article R 716-9-1 of the Public Health Code, hospital admission can be approved by the CHU Director General only after a payment of « a provisional sum that can be recalculated based on the estimated length of hospital stay » to the CHU Treasurer In the case where the hospital stay is shorter than what was planned, the fraction of the unused provisional sum will obviously be reimbursed. The reimbursement will be made to the payer by the inverse process of the initial payment to the Public Treasury. The sum of 6,567.00 € is to be paid to the cashier of the establishment. Or on reception of a bill from PRINCIPLE TREASURY of the CHU of Clermont-Ferrand 78, boulevard François-Mitterand, 63038 CLERMONT-FERRAND establishment code : 30001 (Bank of France) counter code : 00301 account number : D633 0000000 RIB Key : 80
The Assistant Director of the Hospital G. Montpied Director of the Admissions Office JI DAVIGO
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