Garden City Hospital

6245 Inkster Road

Garden City, MI

July 23, 2009

Copy to Doctor Joseph G. D’Avanzo, 18306 Middlebelt, Livonia, MI 48152

Email copy to Medicare.gov
Senator

Dear Madam or Sir:

This is the third time I am saying to you, “I don’t believe I owe you $187.36 for a doctor to ask if I had
anything to eat or drink and my reply of “I had a cup of black coffee.”

I have a letter from Doctor D’Avanzo which states in part “CLEAR LIQUIDS ALLOWED: Water, tea,
coffee (without any milk or milk products)

I have two statements of Medicare paying over $550.0 to Garden City Hospital and Doctor D’Avanzo. One
of the summary of claim was “O Anest, low intestine scope $568.40 of which Medicare paid $133.11 and
$26.62 was in the “You May Be Billed column. I did not receive a statement for that amount.

What was this for? General insensibility to pain with or without the loss of consciousness,
induced by an anesthetic.

Note: I have a letter from Doctor D’Avanzo – so I don’t feel it was my fault I had that one-cup of black
coffee.

I have and enclosing with this letter, a letter from Garden City Hospital “addressed to “Patient or
Designated Representative signed by me Clifford Rayford. The Garden City “Medical Professional with a
signature of L. Bascomb RN” with SPECIAL INSTRUCTIONS D’Avanzo’s office will contact you to
reschedule to reschedule your exam” No one has called to reschedule the exam.

I checked with my primary doctor where my health record is kept. There is a report from Doctor D’Avanzo
office stating something was done, a test or exam, I want Doctor D’Avanzo report removed from my health
record because it is false, no test or exam was done on my body on March 3, 2009.

The reason I am so against paying the $187.36 is because it is 31.7 percent of my monthly pension and I
still have not had the colonoscopy procedure.

Garden City Hospital billing department staff have been very unemotional in their attempt to make me
pay. At age 78, I may end up at some hospital if the present attempt to collect continues.

I reported to Medicare, but the lady I reported to didn’t seem to be concerned.

Clifford Rayford