ASSOCIATED RETINAL CONSULTANTS, P.C.

SURGICAL FEE SCHEDULE

PRELIMINARY TREATMENT COST FOR DRS. TRESE, CAPONE, & DRENSER:

The following is an estimate of the main expenses that you will incur during your medical evaluation and potential surgery.  Please note that all amounts are subject to change and that the funds are payable in U.S. currency only.

 Physician Expenses

(PAYABLE BEFORE ADMIT):

  INITIAL OFFICE VISIT                         $350.00

CHARGE, PER SURGERY                     $5,400.00 (Per Eye)                                        ANESTHESIA, PER SURGERY                $900.00 (Per Eye)

TECH. SURGICAL ASSISTANT             $1,100.00 (Per Eye)

 NOTE:  These expenses are for one eye.  If both eyes have surgery, then these same charges would be billed for the second eye.

Additional Hospital Expenses

(PAYABLE BEFORE ADMIT):

EACH ADMISSION                                        $8,900.00

 TOTAL APPROXIMATE MEDICAL EXPENSES FOR SURGERY ON ONE EYE  $15,520.00

(Includes physician expenses & approx. hospital charges)

GUEST SERVICES / WILLIAM BEAUMONT HOSPITAL

                                                        248  898 8100  /  DEVIN LIPPERT

                                                                                     ASHLEY CORWIN

   Let the ladies know that you will be patient’s of Dr Trese, Dr Capone or Dr Drenser and you will need

   Assistance with transportation and lodging, you will be in Michigan approximately three weeks

 It would be wonderful if this list could include all the costs associated with your visit.  However, during your stay with us, there could be tests ordered and personal expenses incurred in addition to the ones accounted for in the above estimates.

 METHOD OF PAYMENT:

 As your expenses will have to be settled with different providers and accounts, it is important that you are able to distribute your funds accordingly.  This means that you must have a sufficient number of checks to be made out for each type of expense.  For example, a separate check must be made to Dr. Trese, Capone, or Drenser, another one for William Beaumont Hospital, and yet another one for the hotel where you are staying. 

 PAYMENT TO DR. TRESE, CAPONE, OR DRENSER AND PAYMENT TO THE HOSPITAL MUST BE MADE BEFORE THE SURGERY -  Please do not bring one check for all the expenses.

ASSOCIATED RETINAL CONSULTANTS, PC

 PAYMENT PROCESS

 NOTE:  PAYMENT FOR THE DOCTOR AND THE HOSPITAL MUST BE MADE

IN ADVANCE OF THE SURGERY

PAYING DR. TRESE, CAPONE OR DRENSER BY CHECK:

 As explained previously, a separate check must be provided for the doctor’s services.  The check can be made payable either to the appropriate doctor (“Dr. Michael Trese”, “Dr. Antonio Capone Jr.”, or “Dr. Kimberly Drenser”, or payable to “Associated Retinal Consultants, PC” (the name of the doctors medical group.)  Again, this payment must be made before the surgery.

 OR

 PAYING DR. TRESE, CAPONE, OR DRENSER BY BANK WIRE TRANSFER:

Another option is to pay Dr. Trese, Capone, or Drenser by bank wire transfer.  Your bank can transfer funds to our bank as follows:

                       

BANK WIRE TRANSFER TO:       *JP Morgan Chase Bank N.A.

*Routing number: 072000326 for credit to Associated Retinal Consultants, PC

                                                            *Deposit to JP Morgan Account number:  000668884

 (Again this account is only for payment of funds to Drs. Trese, Capone, or Drenser – NOT for credit to William Beaumont Hospital-Royal Oak.)

PAYING WILLIAM BEAUMONT HOSPITAL:

Your payment of $8,900, for the hospital expense must be sent by BANK WIRE TRANSFER before the patient is admitted.  Your bank can wire transfer your payment as follows:

BANK WIRE TRANSFER TO:          *Comerica Bank, Detroit, Michigan

                                                            *Depository Account

*Routing #072000096 for credit to account of William Beaumont Hospital

                                                            *Deposit in Account #1039-039738

                                                            *Include patient name

                                                            **Swift CodeMNBDUS33