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Click here for Electronic Billing and Payment Services!!!

With Insurance

 

Two Insurances Page 1 Date of Service Guarantor Guarantor Guarantor Address Location Account Number For Credit Card Payment Statement Date Primary Insurance Secondary Insurance Amount we are billing insurance

Two Insurances Page 2 What you owe now Date of Service Location About your insurance About you Hospital Summary of Charges Account Number

 

Last modified on: July 26, 2004

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Patient Financial Services

PO Box 800750

Charlottesville, VA 22908

1-800-523-4398

tdd: 434-982-HEAR

Maintained by UVa Medical - Patient Financial Services Webmaster

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