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Whitlow Memorial Hospital, May stay, patient balance (Mom) · $1736.0

personas/caregiver/files/finance/bill-whitlow-may.pdf
documentlook: clean style: statement1 pages render unknown

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                                                                            Patient Financial Services
                                                                         1740 Hensley Fork Drive NW
                                                                                 Cleveland, TN 37311

Whitlow Memorial Hospital                                                              (423) 555-0170
                                                                           whitlowmemorial.example




Patient Statement
Statement date: September 8, 2026       Account: WM-PA-2605-771934

Patient: Lorraine M. Pruitt   Guarantor: Lorraine M. Pruitt, 2217 Larkmoor Lane NW,
Cleveland, TN 37312

Service: inpatient stay, May 20, 2026 to May 22, 2026

 Description                                                                             Amount

 Total charges                                                                        $18,412.60

 Medicare Part A payment                                                              -$9,870.15

 Medicare contractual adjustment                                                      -$6,806.45

 Evermont Health Assurance (secondary), denied August 12, 2026                               $0.00

 Balance due from patient                                                              $1,736.00

Payment due: September 30, 2026

The balance is the 2026 Medicare Part A inpatient deductible. Your secondary insurer denied
the claim with the message "member name does not match". If you have supplemental
coverage, please ask the insurer to correct its records so that we can submit the claim again.

Account note, August 27, 2026: hold placed for 60 days, through October 26, 2026, pending
secondary insurance. No payment is due while the hold is in place.

Billing questions: (423) 555-0170, weekdays 8 to 4:30.

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Record

Whitlow Memorial Hospital, May stay, patient balance (Mom) · $1736.0 Bill · saved Sep 11, 2026

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2render unknown

The record values this file is made from: the ones its text names with {{record.field}}, and the fields its template reads. A value here is in the file's source; whether it is readable depends on the look.

ValueNow
bill-whitlow-may.amount 1736.0
bill-whitlow-may.due_date 2026-09-30

The values at render time were not recorded: the file was rendered before files/rendered.json existed. Rendering it again records them.

Planted

mismatch The Evermont supplement card is in the name LORRAINE H PRUITT (her maiden name Hollis used as a middle initial). Medicare and every other document say Lorraine M. or Lorraine Mae Pruitt. The mismatch is why a $1,736 hospital bill is unpaid.

attachments.yaml 
record: bill-whitlow-may
template: document
style: statement
org:
  name: Whitlow Memorial Hospital
  lines:
  - Patient Financial Services
  - 1740 Hensley Fork Drive NW
  - Cleveland, TN 37311
  phone: '4235550170'
  web: whitlowmemorial.example
  color: '#274b6d'
title: Patient Statement
body: '**Statement date:** September 8, 2026    **Account:** WM-PA-2605-771934


  **Patient:** Lorraine M. Pruitt    **Guarantor:** Lorraine M. Pruitt, 2217 Larkmoor Lane NW,
  Cleveland, TN 37312


  **Service:** inpatient stay, May 20, 2026 to May 22, 2026


  | Description | Amount |

  |---|---|

  | Total charges | $18,412.60 |

  | Medicare Part A payment | -$9,870.15 |

  | Medicare contractual adjustment | -$6,806.45 |

  | Evermont Health Assurance (secondary), denied August 12, 2026 | $0.00 |

  | **Balance due from patient** | **{{bill-whitlow-may.amount|money}}** |


  **Payment due:** {{bill-whitlow-may.due_date}}


  The balance is the 2026 Medicare Part A inpatient deductible. Your secondary insurer denied the claim
  with the message "member name does not match". If you have supplemental coverage, please ask the insurer
  to correct its records so that we can submit the claim again.


  **Account note, August 27, 2026:** hold placed for 60 days, through October 26, 2026, pending secondary
  insurance. No payment is due while the hold is in place.


  Billing questions: (423) 555-0170, weekdays 8 to 4:30.

  '