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Home My WebLink About03-0695RETINA/OCULOPLASTIC CONSULTANTS: IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA VS. : CIVIL ACTION - LAW PEGGY SUE BAER : b~ RICHARD E. BAER : No. ~) ~ -- NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 1;800-990-9108 RETINA/OCULOPLASTIC CONSULTANTS: PEC,(;Y SUE IIAER i,IICHARI) E. BAER IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION- LAW No. (C).~ COMPLAINT ANI) NOW, this Il" da}' of Febnlary, 2003 comes Rctina/()culoplastic Consultants. above-named Plaintiff, by and through its attorney, Gall Guida Soudcrs. t(squirc. and respectfully a,~ers thc following: 1. Plaintiff is a corporation having offices at 220 Grandview Avenue. Camp t lill. Pennsylvania 17257. 2. I)clkndant Peggy Sue Baer is an adult individual residing at 23 Montgomcr3 Avenue. Shippensburg, Pennsylvania 17257. 3. Delkndant Richard E. Baer is an adult individual residing at 23 Monlgomcry Avenue, Shippensburg, Pennsylvania 17257. 4. At the specific instance and request of Delkndant, Peggy Sue Baer, Plaintiff provided medical services to Delkndant at the times, amounts, and thc prices Ibr these services are indicated in PlaintiWs Statement of Account. a true and correct copy of which is attached hereto, marked Exhibit A. and made part lhcreotk 5. 'l he prices charged by Plaintiff the prices that the l)etkndant agrccd to pa3. qhc prices were lhir. reasonable, and market prices that prevailed at thc times ol'lhc transactions. Sec Exhibit B 6. l)el'endant Richard E. Baer was married to Defcndant Peggy Suc Bacr at thc time services were rendered. 7. Allhough Defendant Peggy Sue Baer was the Plaintiff's patient, Defendant Richard Ii. Baer is also responsible tbr paymenl of said services pursuant to 23 Pa.C.S.A. §4102. Plaintil'favers that the balance due amounts to $14.068.00, which is above thc limit lbr mandatory arbitration, As oF January 20, 2003, the interest at the legal rate ol'six percent a year is $1,142.32. 10. Although repeatedly requested to do so by Plaintifl: Defendant has wilH'ully riffled and refused to pay the albresaid balance or any part thereof to Plaintiff: W11EREFORE, Plaintiff respectfully requests that judgment be entered in l'aw~r of Plaintil'f and against Defendant in the amount of $15,210.32 with interest and costs. Respectfully submitted, (Jail Guida Souders, F~squil'e Guida I~aw Offices 503 North Front Street Harrisburg, PA 17101 717-236-6440 Attorney lbr Plaintifl' Supreme Court ID #68740 RETINA AIND OCULOPLASTIC 'CONS 220 GPJ~NDVIEW AVE STE 200 CAMP HILL, PA 170111740 717 761-8688 I. D. # 23-2152842 Prov. # 26390 PEGGY S BAER 23 MONTGOMERY AVE SHIPPENSBURG PA 17257 Fin Class: 8 Ins: Pat: 1-101 2-102 Date Proc Md Description Date: 01/17/02 Account No: 19861.0 Phone: 717/530-7852 Insurance Balance: 0.00 Patient Balance: 14,218.00 Diag INS Charges Credits Balance BAER, PEGGY S 031401 99243 031401 031401 92225 50 OPHTHALMOSCOPY, EXTE 031501 Rebill - 101 042301 Rebill - PAT 031401 92235 50 FLUORESCEIN ANGIOGRA 031501 Rebill - 101 042301 Rebill - PAT 061801 Check Payment - PAT #229 pd on acct 031401 92250 FUNDUS PHOTOGRAPHY, 031501 Rebill - 101 042301 Rebill - PAT 031401 67228 LT LASER PHOTOCOAGULATI 032101 9995 N/C POST OP VISIT 032101 67228 LT LASER PHOTOCOAGULATI 040401 9995 N/C POST OP VISIT 040601 67038 LT PARS PLANA VITR/MEMB 042301 Rebill PAT 040601 67228 LT LASER PHOTOCOAGULATI 042301 Rebill PAT 042301 Rebill PAT 041801 9995 N/C POST OP VISIT 050101 9995 N/C POST OP VISIT 061201 9994 PROCEDURE ONLY 061201 67228 RT LASER PHOTOCOAGULATI 062601 9994 PROCEDURE ONLY 062601 67228 RT LASER PHOTOCOAGULATI 091101 9994 PROCEDURE ONLY 091101 67228 RT LASER PHOTOCOAGULATI 092401 Rebill - PAT {19861.0) PHYS-REFERRED CONSUL 362.02 ZPAT Check Payment - PAT #208 362.02 SPAT 362.02 SPAT 155.00 170.00 406.00 362.02 SPAT 90.00 362.02 SPAT 362.02 ZPAT 362.01 ZPAT 379.23 ZPAT 379.23 SPAT 379.23 SPAT 362 02 ZPAT 362 02 ZPAT 362 02 ZPAT 362 02 SPAT 362 02 ZPAT 362 02 ZPAT 362 02 ZPAT 362 02 SPAT 2 226.00 0.00 0.00 0.00 4 748.00 2,226.00 0.00 0 00 0 00 2,226 00 0 00 0 00 0 00 2,226 00 155.00 155.00 0.00 170.00 0.00 170.00 0.00 170.00 576.00 0.00 576.00 0.00 576.00 100.00 476.00 0.00 0.00 0.00 0.00 0.00 9 9 11 11 11 11 14 0.00 14 566.00 566.00 566.00 2792.00 2 792.00 2 792.00 2 792.00 7 540.00 7 540.00 9 766.00 9 766.00 9 766 00 9 766 00 766 00 766 00 992 00 992 00 992 O0 992 00 218 00 218 00 TOTAL CURRENT 31-60 Insurance 0.00 0.00 0.00 Patient 14,218.00 0.00 0.00 Tetat 14,218.00 0.00 0.00 61-90 0.00 0.00 0.00 91-120 0.00 0.00 0.00 OVER 120 0.00 14,218.00 14,218.00 Exhibit A 81/82/2883 18:47 7)7751§G04 ROPC PAGE 0i · PATI.~VT ~NFORMATION: Pa, ien~' s Name (~i,(~ Miss)'?e.. ~ ~t ~ b~Ml~- HomePhonei~tkf] ./'~---~C~?~_,~._~7'o. ' Occupation '~_~4' Work Phone ( -~. ) ~ . Employer ~"' Circlc the following: Single /~/ Widowed/ Separat~ / Divorced Male~--~-~9 Referred to us by whom? Your family physician b~..t~o~,ne,~n,~C~or~or~ Address k)m\r,~ ,,.{~-~, ~. ,~ k.~ EmergenCY coat. ct if we a. ~e to r~ch yo,~/i~ ~ A'~-~, Remtionshiv of mat ~rson ~o you ~ c, .,-,k~,~, ~ Pho, e # ¢'~ ~ 9 ) _4'"X~ -'7 INSURANCE INFORMATION: co. .... ' ~ Ad.ss Is this an HMO, CCPPO or PPO? , Do you need a refexral? Co-pa~ t~Yd~." Secondary Insurance Co. Subscriber's name Insurance Add,ess. !.D .# Crtoup # ts this an HMO, CCPPO or PPO? Do you need a referral? . ..Co-pay? FINANCIAL ASSIGNMENT AND AGREEMENT: Please remember that insurance is considered a method of reimbursing the patient for fees paid to the doctor and isnot a substitute for payment. Some companies pay fixed allowances for certain procedures, zad o~ers pay a percentage of thc charge. It is your responsibilit3' to pay any d~luetJble amount, coinsurance, or ~ny other balaace not paid for by your iasur~nce. In order to control your cost of billinEs, we request that oar cbnrges for ofl'~e visiis be paid a! the conclusion of eseh visit unless you ~.e covered by Medlenre. I ze~iu~st that payment of authorized Medicare and/or insurance b~nefi~s be made on my behalf for any services .furnished me. Thi~ assignment will re,n~in in effect until revoked by mo in writing. I understand thai I am £man~ially : responsible for all ch~ges wh~hvr or not paid by said insurance. I hereby authorize said assignee to releas~ all /." information nee~ssary J~xsecum the payment. Exhibit B 01/22/2003 14:20 FAX 2388599 8UIDA LAW OFFICES ~008/008 RE I'IN,~/¢)CUI,¢)I~LASTIC C()NSULTA~I'.s: IN TIlE COURT ()F (:OMMON I~I, EA.~ : CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL ACTION -I,AW I'E(;(;~' N. BAER rl('llAlll) BAI~bl : No. VF, RII"ICA'J'ION I 'v'I.:RII:Y I'tIAT TILL.' STAT!!MENTS MADf'I IN TIllS C()MPI,AINt ARI:I I'l,~l Il! AND C()RItI~C'I. I UNDERSI'AND TI'IAT TI lid S'I ATEMEN'I'N J II~RI~IN ARI~ MAr')F NI 'B.II:C'I I O TH]'.: PI~NAI,"I']ES OF 18 PA.C'.S.A. SECTION 4c~04 Rt~I,A'I'INti i'() TiLIC' RETINA/OCULOPLASTIC CONSULTANTS: IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA VS. ., : CIVIL ACTION - LAW PEGGY SUE BAER : RICHARD E. BAER : No. 03-695 CIVIL CERTIFICATE OF SERVICE I hereby certify that on February 23, 2003, I served the Civil Complaint upon the person and in the manner indicated below, which service satisfies the requirements of Pennsylvania Rule of Civil Procedure. 403: Personal service by James Stamos to: Richard E. Baer 23 Montgomery Avenue Shippensburg, Pennsylvania 17257 Gail Guida Souders Guida Law Offices, P.C. 503 North Front Street Harrisburg, PA 17101 717-236-6440 Dated: March 13, 2003 RETINA/OCULOPLASTIC CONSULTANTS: PEGGY SUE BAER RICHARD E. BAER IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : : CIVIL ACTION - LAW NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY/BAR ASSOCIATION · 2 LIBERTY AVENUE CARLISLE, PA 17013 1-800-990-9108 TRUE (.,OPY FROM RECO~'~ M Te~tn,,ony wl',emof:, ! h~re unto ~ ~ of ~ Cmj~ aC Ca,isle RETINA/OCULOPLASTIC CONSULTANTS: VS PEGGY SUE BAER RICHARD E. BAER IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL ACTION - LAW : No. TO: Peggy Sue and Richard E. Baer DATE OF NOTICE: April 2, 2003 IMPORTANT NOTICE YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE COURT AN ANSWER TO Plaintiff's Complaint. UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF THIS NOTICE, A JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP: CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 1-800-990-9108 Gail Guida Souders Guida Law Offices, P.C. 503 North Front Street Harrisburg, PA 17101 (717) 236-6440 Identification #68740 Attorney for Plaintiff RETINA/OCULOPLASTIC CONSULTANTS: VS : : PEGGY SUE BAER : RICHARD E. BAER : IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATE OF SERVICm I hereby certify that I am this 2nd day of April, 2003, serving the Default Notice upon the persons and in the manner indicated below which service satisfies the requirements of Pennsylvania Rule of Civil Procedure, 403: Service by First Class U.S. Mail: Peggy Sue and Richard E. Baer 23 Montgomery Avenue Shippensburg, PA 17257 Gail Guida Souders -- -~ RETINA/OCULOPLASTIC CONSULTANTS: VS PEGGY SUE BAER RICHARD E. BAER IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 03-695 Civil Term PRAECIPE To Prothonotary: Retina/Oculoplastic Consultants Please enter judgment in favor of plaintiff, '~:~ .... ~ ~- and against defendants, Pegg~ Sue and Richard E. Baer for failure of defendants to plead to plaintiff's complaint as follows: $15,210.32 plus costs. Date: Respectfully submitted, Gail Guida Souders Guida Law Offices, P.C. 503 North Front Street Harrisburg, PA 17101 717-236-6440 Identification #68740 Attorney for Plaintiff RETINA/OCULOPLASTIC CONSULTANTS: : VS : : PEGGY SUE BAER : RICHARD E. BAER : IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. CERTIFICATE OF SERVICE I hereby certify that I am this 2nd day of Ap~l,~200~ serving the Default Notice upon the persons and in the ~an~ ~' indicated below which service satisfies the requirements of Pennsylvania Rule of Civil Procedure, 403: Service by First Class U.S. Mail: Peggy Sue and Richard E. Baer 23 Montgomery Avenue Shippensburg, PA 17257 Gail Guida Souders -- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY - PENNSYLVANIA Retina/Oculoplastic Consultants Civil Division vs. No. 03-695 Richard E. Baer and Peggy S. Baer SUGGESTION OF BANKRUPTCY To: Prothonotary Please note upon the record that Richard E. Baer and Peggy S. Baer, the defendants in the above-captioned action, filed a Voluntary Petition in Bankruptcy with the United States Bankruptcy Court for the Middle District of Pennsylvania at Harrisburg, PA, on February 23, 2005, at 8:55 o'clock A.M., which petition was docketed to 1-05-00982. PURSUANT TO THE PROVISIONS OF 11 U.S.C. 9362(A), AN AUTOMATIC STAY IS IN EFFECT FOR ALL PROCEEDINGS INVOLVING THE ABOVE-NAMED DEFENDANT(S). CERTIFICATE OF SERVICE I, Richard L. Bushman, Esquire, attorney for the above captioned defendant(s) in the bankruptcy proceeding before the United States Bankruptcy Court for the Middle District of Pennsylvania, do hereby certify that on the date set forth below I served the within "Suggestion of Bankruptcy" by depositing a copy of the same in the United States Mail, postage prepaid, at Spring Run, Pennsylvania, addressed to the parties or attorney's of record as follows: Retina/Oculoplastic Consultants 220 Grandview Avenue Camp Hill, PA 17257 Guida Law Offices PC 111 Locust Str Harrisburg, L. us man, Esquire Path Valley Road P. . Box 51 Spring Run, PA 17262-0051 Date: February 28, 2005 [717] 349-7657 ~ . ~ " ">"" f -" ... . .w-l' - ---