October 20, 2005
Page 2
October 20, 2005
Lynette Esteves Ball
766 1st St #23
Gilroy Ca. 95020
Dear Sir or Madam:
To whom this may concern, included is a list and copies of receipts for medication that I was forced to pay cash for as I have not received my medical cards as of yet. I have made several requests for a cards so that I do not have to had submit and pay for this medication out of pocket. Please re-embers me for the money spent to fill these medication needs. As of today I still have not received my medical cards and do not have my correct subscriber number as of yet. I have listed the medication, date of purchase and dollar value for each transaction.
Hydrocodone / 10/15/05 / 23.93Carisoprodol / 10/15/05 / 26.45
Provigil / 8/10/05 / 91.59
Provigil / 9/26/05 / 134.29
Clonazapam / 9/26/05 / 46.99
Clonazapam / 9/15/05 / 46.99
Ambien / 8/10/05 / 116.99
Clonazapam / 8/10/05 / 81.29
Fentanyl / 9/23/05 / 143.49
Hydrocodone / 9/23/05 / 29.49
Ambien / 9/26/05 / 61.49
Alprazolam / 9/29/05 / 12.99
Hydrocodone / 9/29/05 / 35.99
Carisoprodol / 9/29/05 / 35.99
Carisoprodol / 9/15/05 / 20.59
Hydrocodone / 10/03/05 / 27.69
Levaquin / 08/25/05 / 129.99
Fentanyl / 10/05/05 / 129.95
Hydrocodone / 10/13/05 / 35.99
Provigil / 9/07/05 / 48.79
Provigil / 8/26/05 / 91.59
Fentanyl / 10/1/05 / 129.99
I have included copies of receipts for all of these transactions. My Social Security number is SS# 549-63-3924 and my date of birth is 12/08/70. It is my understanding that my medical insurance number 7050358-01 and that my group number is 147152 I do not have any other insurance information
Please fee free to contact me directly at my home address of 766 1st Street #23 Gilroy, Ca. 95020 of by telephone at 408-846-9031 . Please note that I have recently gotten married and that I am in the middle of changing my last name from Esteves to Ball. On some receipts you will see Lynette Ball, others you my see Lynette Esteves Ball and on others you may still see Lynette Esteves. I would appreciate prompt re-imbursement or if you need additional information please contact me immediately.
Sincerely,
Lynette Esteves Ball