Tonya Morgan

 
 Ochsner 
 Health 
 Amanda Huff
 THIS IS NOT A BILL 
 3512 Toledano Street 
 NEW ORLEANS LA 7028 
 #829828). The following document contains the itemized services requested for Karen Marie Johnson (Guarantor 
 Coverage(s) on file: 
 Humana - Humana POS 
 Charges 
 Insurance Pmts/Adjs 
 Patient Payments 
 Patient Adjs 
 Total Balance 
 28,911.55 
 -20,136.12 
 -1,553.35 
 -3.42 
 7,218.66 
 Marie Johnson) 
 Emergency Visit to Ochsner Baptist - A Campus of Ochsner Medical Center (Acct#83000069728 for Karen 
 Service Svc Date Dates:2014/04/08, 2013 to 2014/27/10
 Description 
 Charges 
 Qty 
 Amount 
 07/29/13 
 25000003 
 07/29/13 
 Morphine 2 Mg/MI Crtg 1 MI Syringe (0409-1762-30) 
 25000003 
 1 
 10.00 
 07/29/13 
 Sodium Chloride 0.9% 0.9 % Solp 1,000 MI Bag (0264-7800-00) 
 76705 
 1 
 10.00 

 Total Charges 
 2,667.43 
 Insurance Payments and Adjustments 
 2018/13/07 
 10226 
 Contractual Write-Off 
 2018/13/07 2000 
 1 
 -1,669.15 
 Insurance Payment 
 1 
 -424.48 
 Total Insurance Payments and Adjustments 
 -2,093.63
