Dental Office Letter

Dr. James Bond

1234 Goldfinger Way

Vancouver, BC, V6K 2G4

Telephone: 604-220-2000

Date: May 06, 2010

Mr. Johnny Depp

1403 1755 Haro Street,

Vancouver, BC, V7L 1P5

Dear Mr. Depp,

Subjet: Bill Payment

I am corresponding on behalf of Dr. James. Bond. This is to inform you about the payment for your recall appointment on February 15, 2010 with Dr. Bond. The total fee for the above mentioned appointment was $132.10. As we have noted that you have dual coverage. Of the total fee, 80% was billable to your primary insurance carrier.

Our office policy is to accept assignment only with the primary carrier. Under this scenario ...