Newspaper Page Text
PAGE 10
THE FOREST PARK NEWS, THURSDAY, MAY 25, 1967
MEN
IN
SERVICE
PAUL M. ANDERSON
GREAT LAKES, Ill.—Seaman
Recruit Paul M. Anderson, 18,
son of Mr. and Mrs. James D.
Anderson Sr. of 139 Lakeshore
Drive, Forest Park, has been
graduated from nine weeks of
Navy basic training here.
In the first weeks of his naval
service he studied military sub
jects and lived Aid worked under
conditions similar to those he
will encourter on his first ship
or at his first shore station.
ROBERT D. MABREY
GREAT LAKES, Ill.—Seaman
Recruit Robert D. Mabrey, 18,
USN, son of Mrs. Nyra L. Cook
of 154 Courtney Dr., Forest
Park, has been graduated from
nine weeks of Navy basic train
ing here.
In making the transition from
civilian life to Naval service,
he received Instruction under
veteran Navy petty officers. He
studied seamanship, as well as
survival techniques, military
drill and other subjects.
DEWEY L. JACKSON
FT. CAMPBELL Ky.—Army
Private Dewey L. Jackson, 22,
son of Mr. and Mrs. Arnett
E. Jackson, Route 2, Hixson,
Tenn., fired expert with the
M-14 rifle near the completion
of basic combat training here.
The expert rating is the high
est mark a soldier can achieve
on his weapons qualification
test.
Pvt. Jackson’s wife, Lydia,
Ilves at 333 Main St., Morrow.
EDWARD L. YOUMANS
USS DOUGLAS H. FOX —
Radioman Third Class Edward
L. Youmans, USN, son of Mr.
and Mrs. C. C. Youmans of
1207 Cypress Drive, Forest
Park is on extended anti-sub
marine exercises off the Unit
ed States east coast as a crew
member of the destroyer USS
Douglas H. Fox.
JOHN W. MARTIN
JACKSONVILLE, N.C.—Mar
ine Private First Class John
W. Martin, son of Mrs. Mar
garet O. Martin of 1417 Pine
Glen Drive, Riverdale, was gra
duated from a course on Elec
trical and Aviation Instrument
Systems Maintenance at the
Marine Corps Air Facility,
Jacksonville, N.C.
RONALD A. JONES
CAMP LEJEUNE, N.C.—Mar
ine Private First Class Ronald
A. Jones, son of Mr. and Mrs.
Johnny J. Jones, Sr., of Route
2, Riverdale, has completed the
Motor Vehicle Operator’s
Course at Motor Transport
School, Marine Corps Base
here.
JOHNNY E. CASON
GREAT LAKES, Hl.—Seaman
Recruit Johnny E. Cason, 18,
USN, son of Mr. and Mrs. Eli
jah C. Cason of 108 Granade
Dr., Forest Park, has been
graduated from nine weeks of
Navy basic training at the Naval
Training Center here.
In making the transition from
civilian life to Naval service,
he received Instruction under
veteran Navy petty officers.
To Our Fine
Graduates! <
\\ V T
\ U f
Best of luck as you J A >^7l
move on to a bright J f / Ir I
and happy future .. . ' | q /
W\ I ‘ ‘
WM. J. (BILL) LEE
State Representative
CLAIM FORM ACCURACY
VITAL FOR MEDICARE PAY
The key to speedy processing and payment of
Medicare claims for physician’s services Is to
make certain the Request for Payment claim
form is correctly and fully completed.
The basic advice Is stressed by Maurice F.
Stevenson, director of Part B Medicare in
Georgia for the John Hancock Mutual Life
Insurance Co.
Hancock and other major Insurance companies
with experience In administering private health
Insurance programs perform basic Medicare
claim processing and administration for the
government throughout the nation.
The necessity for keeping claim form errors
to a minimum to assure orderly processing
Is apparent from the volume of claims being
filed each month.
As of January there were 302,000 Georgia
residents enrolled in Part B and the number of
monthly claims payments has jumped from
a modest 13 for July, 1966, when the program
started, to a current peak of nearly 30,000
monthly.
Under Part B of the medical insurance pro
gram for persons 65 or over, the patient must
Incur SSO of covered expenses such as doc
tor bills In a calendar year before receiving
Medicare payments. The federal government will
pay for 80 per cent of other reasonable charges
for all Part B services.
A unique feature of the SSO deductible pro
vision Is that doctor’s bills used for satisfy
ing the deductible In October, November and
December are credited toward establishing a
new SSO deductible base for each succeeding
calendar year.
However, a SSO deductible must have been
established previously for the current year.
Some confusion exists In the minds of many
citizens over the two options available for se
curing Medicare payments.
Congress has given physicians the option of
making direct application for Medicare pay
ments for 80 per cent of the reasonable charge
for medical services provided Medicare pa
tients or the patient may seek reimburse
ment from the government directly after pay
ing medical bills.
The same Request for Payment claim form
— SSA-1490— is used in filing for both pay
ment methods. These forms may be secured
at the offices of many physicians, at any of
the 18 local Social Security offices In Georgia,
at the John Hancock’s Medicare office in At
lanta or at any John Hancock sales office In
the state.
Regardless of which option is exercised, the
full name of the Medicare patient and his Health
Insurance claim number must be filled out ac
curately In the upper right hand corner of the
Request for Payment claim form.
It Is suggested the name of the patient be
typed or printed to assure speedy identifica
tion during processing.
Where the physician agrees to seek direct
payment from the government, patients should
show the doctor their Health Insurance cards
for identification.
The red, white and blue identification cards
carrying the patient’s Health Insurance (H.1.)
claim number are Issued by Social Security.
Persons who lose their cards should contact
the nearest local Social Security office to get
127 Seniors to Graduate
From Woodward Academy
Graduation festivities begin
today for Woodward Academy
seniors. It is Interesting to
note that the Class of ‘67 has
the distinction of being the first
to graduate from the Academy
since Its name was officially
changed from Georgia Military
Academy to Woodward Academy
In February of 1966.
In special ceremonies this
morning, the 1967 Grenadier,
the school yearbook, was de
dicated. (Tom Stribling of De
catur edited this edition of the
Grenadier.7 Hhe ..luuinr-Senlor
another one.
To complete the assignment process, patients
must check Yes on Line 4.
It is also necessary for patients to give the
date their signature Is entered on Line 5
and care should be taken to make certain the
full address, including city or town of the
patient, Is legible on Line 6.
Physicians are required to check Line 12
Indicating they accept assignment of the bill
and will make direct application to Social
Security for payment.
The responsibility for filling out the claim
form falls on the patient in instances where
the doctor does not make application for pay
ment.
The physician can elect to have the patient
apply for reimbursement simply by declining
to accept assignment of the patient’s claim or
the patient can elect to make direct applica
tion for reimbursement on paid medical ser
vices or expenses.
The cooperation of the physician would be
helpful In completing the claim form.
It is most Important that the physician supply
the patient with an itemized bill giving: date
of each service, place of service, nature of
medical procedures, services or supplies, na
ture of Illness or Injury requiring services or
supplies and charges.
In describing the nature of medical proce
dures or services, physicians have been urged
to use the numerical codes and technical vo
cabulary of either the “Current Procedural
Terminology,” second edition, published by the
American Medical Assn., or the “California
Relative Value Study.”
The attachment of an itemized, receipted bill
Is acceptable. However, it is preferred that the
physician fill out Part II of the Request for
Payment form. We must remember this service
Is voluntary on the part of physicians.
For patients who are completing the claim
form, the procedur is relatively simple.
In Part I — Claims Information, patients are
required to write a brief description of the Ill
ness or injury for which they received treat
ment.
For example, a patient who suffered a broken
forearm would simple write Broken Arm. In
medical terminology the description would be
Fractured Radius, but patients filing claims
are not expected to use this precise medical
terminology.
Line 2 simply requires the patient to check
the Yes or No boxes on whether the illness
or Injury was connected with employment.
Line 3 similarly Is self-explanatory. It asks
whether the patient is attaching an itemized
receipted bill from the physician or if the doc
tor has completed Part n, including Line 13
calling for the doctor’s signature.
On Line 4 the patient would check No to the
question, “Do you want payment for an unpaid
bill made directly to the physician or supplier?”
If the patient Is personally filing a claim for
reimbursement.
Assistance In completing claim forms can be
secured at any Social Security Office.
All claims should be mailed to: Medicare 04-
110, John Hancock Mutual Life Insurance Co.,
230 Houston Street, NE, P.O. Box 7340, Station
C, Atlanta, 30309.
Prom will be an event of to
morrow night In the M. C. Pa
get gymnasium.
Saturday’s schedule Is filled
with events heralding com
mencement. At 10:30 a.m. the
Military Review will be pre
sented and military medals and
honors will be awarded at that
time. Later, at 1, the Senior
Banquet will be held In the
gymnasium. Senator Herman E.
Talmadge will be guest speaker
for this event. Finally, on Sa
turday night at 8, seniors will
receive those long-awaited di
plomas.
Baccalaureate Services for the
graduates were held last
Sunday In the Richard C. Gres
ham Chapel which was recently
dedicated. Sunday afternoon ac
tivities honoring seniors in
cluded a Glee Club recital, Mi
litary Review and the Presi
dent’s Reception for Senior
Class members, their parents
and faculty members.
This year’s graduates Include:
Brent Wheeler Allain; Calvin
Randolph Allen, Jr.; Lee Al
theimer; William Welch As
bury; Timon Hayden Atkins;
Henry Vivian Bailey, HI; Ken
neth Roger Baldowski; Julian
Samuel Betts, Jr.; Stephen
Claude Betts and Clifford N.
Bostic, Jr. Also, Louis Carl
Bowen, m: Robert Platt Boyd,
III: James Artell Brasfield, Jr.;
Robert Lee Brooks; Christo
pher Joseph Brumlik; Michael
Robert Burris; Christopher
Stephen Byrnes; Earl Rodney
Canfield, Jr.; Mark Scott Cap-
Unger, Mark Clayton Carson;
William Calmer Cato, Jr.;
George Thomas Chapman; John
Andrew Coleman, Michael Da
vid Cornell; Walter Remington
Creighton, Jr.; and Andrew
Denton Croft, Jr.
Other graduates are Cecil
Knox Daniel, Jr.; Charles An
drew Davis; Kim Michael De
laney; James Marshall Dela
shaw; David Lawrence deLes
dernler; James Stephen Dish
roon; Stanley Robert Duren;
Lane Foster Ellington; Leon
ard Lee Ellis, in: Wilburn Ho
ward Fant, Jr.; Michael John
Fedack; Chrisp Bradley Flynt;
Peter Elmer Foss; Daniel Ross
Gill; Andrea Lyle Graves;
Larry William Green; David
Steven Gross; Walter Earl
Groover and Edward Charles
Grundy. In addition, John Ed
ward Hamilton; Richard Floyd
Hammontree; Stephen Eugene
Harris; Ted Cecil Hays, Jr.;
George Norman Hemperley;
Thomas Foster Hinton; Char
les Graham Hixon, HI; Guy
Richard Howard; Raul de Je
sus Hoyo; Keth Hudson, Chris-
topher Douglas Johnson; Jef
frey B. Jones, Glenn Joseph
Jurczyk; Dewey P. Kelley, II;
and Philip Edgar Kite.
Also, Robert Richard LaMoe;
Frederick Poole Landers; Da
vid Lee Larence, Jr.; William
Branch Lawson; David Stock
ard LeCraw; Floyd Calvin Le
wis; Stanton Foster Lloyd;
Pressly Andrew Love; Douglas
Swan McAdams; Louis Stubbs
McCann, Jr.; Milton Samuel
McGarlty; John Donald Mc-
Rae and Andrew Louis Mar
golles. Continuing the list of
graduates are Glen Russell
Marsh; Frederick Herbert
Martin, Jr.; Robert Lee May,
Jr.; Ernest Felder Middleton,
III; John Thomas Miles; Ter
ence Lee Nelson; Robert Carl
Osburne; Dwight Harris Ox
ford; James Lane Paulk; John
Scott Payne; Thomas Frederick
Peace; Charles Jackson Pend
ley; Raymond Lupton Pittman,
III; Nell Hamilton Potter and
Robert Bishop Prince.
Other seniors are Charles Ed
ward Rhodes; Henry Edward
Rhodes, Jr.; Christopher Jo
seph Michael Roesel; Nathan
Leßoy Rohde; Richard Allen
Rossback; Robert Baxter Rus
sell, Jr; Mark Lance Schon
brun; Steven Wayne Seaman;
James Warren Segars; Harry
Brown Sewell, Jr.; Glenn Thom
as Seymour; Stephen Alan
Sharp; Thomas Warren Shul
man; Deborah Smith; Kenneth
Stephen Starnes; Edwird Mc-
Intosh Street; Thomas Charles
Stribling; Kirkman Hart String
fellow; and Victor Randolph
Suchke. Also, Raymond Carr
Talton; Addison Terry, H;
Hughes William Thompson, ni;
John Wallace Vann, HI; William
Albert Van Wout; Clarence Ro
land Vaugn, III; Frank Arthur
Vella; Charles Russell Walker,
Jr.; Jacquelyn Kay Warr; Rus
sell Wayne Warren; Walter
Keith Watkins; James Yates
Weathers; Elgin Miles Wells,
Jr.; Joseph Rufus Williams,
Blood Donor Drive By
New Woodward Chapter
The Randolph W. Thrower Chapter of the National Honor
Society which was recently installed on the Woodward Academy
campus chose a blood donor’s drive for its first project.
Many of the students 18 years and over enrolled in the Aca-
Participated in the drive. The blood will be distributed
to the Atlanta area hospitals by the Atlanta chapter of the
American Red Cross.
James A. Paulk, a senior from Ocilla, was responsible for
the arrangement of this drive. According to Paulk, the Red
hosplUls U dally S approxlmatel y 300 P ,nts of blood ‘o Atlanta
REQUEST FOR PAYMENT
social sccumrv aqmihistma now MEDICAL INSURANCE BENEFITS—SOCIAL SECURITY ACT
t t (Typo or Print all Information) * t
PuEAst PETUWN ro Copy from of beneficiary
MEDICARE 04-110 your HEALTH
JOHN HANCOCK MUTUAL LIFE INSURANCE CO INSURANCE
230 Houston street, n. e. rApn a Mrs. Mary Brown
P O BOX 1832 LAKU CLAIM NUMBER
ATLANTA. GEORGIA 30301 251-33-810? A | |male FEMALE
PART I—CLAIMS INFORMATION—TO BE COMPLETED BY PATIENT.
I. Describe the illness or injury for which you received treatment. (You do not need to complete this item if your doctor completes
Part II below)
Fractured Radius
2. Was your illness or injury connected .—.. —. 3. Are you attaching itemized
with your employment? | | YES | y | NO receipted bills? | | YES |y | NO
4. ASSIGNMENT: Do you want payment for an unpaid bill made directly to the physician or supplier? Q YES | | NO
AUTHORIZATION: I authorize release of any information required to act on this claim and permit a photographic or other '
facsimile reproduction of this authorization to be used in place of the original.
REQUEST FOR PAYMENT: I am requesting payment either to myself or to the party accepting my assignment for the medical
insurance benefit, if any, payable for the reasonable charges for services or supplies described. Where payment is assigned. I under
stand I am responsible for the deductible and 20% of the remaining reasonable charges.
5. SIGNATURE (Palitnt or aulhoriied rrpnienMlrel signed
6. *OP"ESS (Streetaddre„. City. State. ZIP Cod.) ' TELERMO ne NUMBER
123 Smith Avenue
Atlanta, Georgia 777-5 1 +39
.. ............ „ This Part, Including Physician's Signature,
PART II—REPORT OF SERVICES—TO BE COMPLETED BY PHYSICIAN— Need Not Be Completed If Paid, Itemized
_ Bills Are Submitted.
7. A. B. c. ' ’]~
DATE OF PLACE FULLY DESCRIBE SURGICAL OR MEDICAL NATURE OF ILLNESS OR Loavu
EACH OF PROCEDURES ANO OTHER SERVICES OR INJURY REQUIRING SERVICES CHARGES Blank
SERVICE SERVICE 1 SUPPLIES FURNISHED FOR EACH DATE GIVEN OR SUPPLIES (Diagnosis)
2-5-67 0 Manipulation & Casting (0807) Fractured Radius <75.00
X-Ray (7255) " 10.00
—— I
2-17-67 0 Follow-up Office Visit ((00^) " 5.00
2-28-67 0 Follow-up X-Ray (7255) " 10.00
3-3-67 Cl Re-cast " ~
(included in manipulation)
3-17-67 0 Remove Cast " ~
(included in manipulation)
iFinal X-Ray (7255) 10.00
8. NAME AND ADDRESS OF PHYSICIAN OR SUPPLIER (Number and street, City, TELEPHONE NUMBER a T«»«l
State. ZIP Code) '® Tai $
Charges 110 00
Dr. John B. McDonald to Amount .
7318 Venice Street CODE no. I Paid I
Atlanta, Georgia 30301 1234- nT A^unpoid . “
12. ASSIGNMENT OF PATIENTS BILL r - 1, accept assignment 111 do not accept assignment
(See reverse) LXJ I I
13, SIGNATURE OF PHYSICIAN OR SUPPLIER (A physician's signature certifies that physician's DATE SIGNED
k services wepe personally rendered by him or undgj^his personal direction) r~ I r~~i DOS t j *
<O—Dodor'4 Office IH—lnpatient Hospital ICF—Extended Caro Facility OL—Other Locations (Specify in 7CI I
IL—lndependent Laboratory fyivo name and address in 7CI H—Patient’s Home OH—Outpatient Hospital NH—Nursing Home
FORM SSA 1490& 4-ee) .
MEDICARE PHYSICIAN PAYMENTS—There are two options for payment of physician ser
vices in Medicare. Form SSA-1490, available at the doctors’ offices, Social Security offices,
and the John Hancock’s Medicare Office In Atlanta, Is used In both Instances. In first option the
doctor bills the government, Illustrated above where anX Is placed In Yes box on Line 4 and by the
X on Line 12. In second option the patient pays the bill and then seeks Medicare reimbursement.
The NO box on Line 4 would be checked in latter case. When patient files, he should Include a
“Paid ’ Itemized bill from doctor and have the doctor fill out Part n and sign line 13.
Babb Students
Guests of
Kiwanians
Twenty-two top students
of Babb Junior High School
in Forest Park were pre
sented to the Kiwanls Club
members at their meeting
last Thursday night by the
school’s Mrs. Roumania Las
siter.
Sixteen of the 22 are girls.
All have been named on the
honor roll during the whole
school year. They are from
the seventh, eighth and
ninth grades.
Mrs. Lassiter spoke on
curricular activities and re
viewed the school’s progress
and accomplishments.
The honor students pre
sented were: Mary Lou
Burks, Doug Crowe, Sheryl
Hale, Dale Hoffman, Karen
Mayfield, Kathy Baker, An
dria Carnes, Renee Guice,
Marilyn Ingram, Teresa
Mauldin, Debbie Parkerson,
Beverly Spears, Carla St.
Romain, Ann Waldron, Ann
Weatherly, David Chapman,
Spencer Ellis, Elliott Law
rence, Nancy McCannon, Su
san Rhodes, Diane Taylor
and Cindy Uhl. Two other
honor students, Kay Dur
rance and Rebecca McCol
lum, were not present.
Training Union
Assembly
me annual Georgia Baptist
Training Union Assembly will
be held on the campus of Mer
cer university, Macon, June
5-9, with more than 500 Train
ing Union leaders expected for
the week-long session.
A feature in Georgia Baptist
n and John Parkerson Wood
side.
John Parran Richardson
Woodward; Steve Alan Young
and Wayne Clayton Zehms com
plete the list.
denominational life each year,
the Assembly provides a week
of inspirational messages,
Summer Employment
Opportunities
Temporary office assignments offering challenge, variety
and top hourly salary for experienced or trained.
Secretaries
Typiata
Keypunchers
Clerks
CHECK IN TODAY WITH
11ISII FIHtCE
161 Peachtree NE
Suite 514 - 577-4616
To Our Fine
Graduates I
\\
Best of luck as you V \ J
move on to a bright \ \ V . I
and happy future . . .
WK? T i I u
JOE MUNDY
Clayton County Superior Court
training in teaching techniques
and methods, and an opportunity
for fellowship.
Acting School
Summer Course
Lois Broad, executive direc
tor of Theatre Atlanta’s adult
acting school, announced be
cause of popular demand the
school will be continued during
the summer months. Mrs.
Broad said that in reply to
numerous requests the school
will also include body move
ment, pantomine, directing and
history of theatre, In addition
to acting, voice, oral Interpre
tation and phonetics.
Registration will begin May
29 and continue through June
3. The classes will start June
5 and continue through August
12. For information and re
gistration call 876-2003 be
tween 2 and 4 p.m. on the re
gistration dates above.
Legal
Notice
NOTICE OF SALE UNDER POWER
GEC ’’GlA—Clayton County
Wbt.eaa, heretofore on January 10, 1966,
WUllain P. Driver did execute to Modern
Homee Construction Company, a Fiori*
Corporation, a certain security deed to the
following described land:
AU that tract or parcel of land i^at and
being In Land Lots 20 and 21 ot the 13th
District of Clayton County, Georgia, being
Lots 17 and 18, Block, 13, Maxwelton Sub
division, According to Plat by WJ. Lee,
Engineer, dated September 13, 1900, and
restaked by Watts and Browning, Engin
eers, dated Aprtl 1950, recorded In Plat
Book 3, Page 9, Clayton County records,
and being more particularly described as
foUows:
Said lots beginning at an Iron pin on the
west side of Dodson Avenue, 70 feet north
from the northwest corner of the Intersec
tion of Blalock Street and Dodson Avenue;
and thence running west along the south side
of Lot 15, Block 13, a distance of 158
feet to an Iron pin; thence running south
along the east side of Lots 8 and 9 Block
13, a distance of 70 feet to an iron pin
on the north side of Blalock Street; being
the distance across the backs of Lots 17
and 18, Block 13; thence running east
along the north side of Blalock Street a
distance of 158 feet to an Iron pin at the
northwest corner of the Intersectton of Bla
lock Street and Dodson Avenue; thence
running north along the west slds of Dodson
Avenue a distance of 70 feet to an Iron
pin, being the distance across the front at
lots 17 and 18, Block 13, the POINT OF
BEGINNING.
To secure a note of even ante tnerewttb
for 311,488.32, all as' shown by a security
■ deed recorded In the Office of the Clerk
ot the Superior Court ot Clayton County,
Georgia in Book 422, page 750-751; and
I
Whereas, said note imb oecome in default
as to principal, and the undersigned elects
that tbs entire note become due at once;
Now, therefore, according to the original
terms ot said security deed and the laws
In such cases made and provided, the under
signed will expose for sale to the highest
and best bidder for cash the above-described
land, alter proper advertisement, on the
first Tuesday in June, between the legal
hours ot sale before the courthouse door
in Jonesboro, Clayton County, Georgia. Ths
proceeds from said sale win be used, first
to ths payment ot said note and expenses,
and the balance, If any, delivered to the
said william P. Driver.
This 3rd day ot M£y, 1937.
Modern Homes Construction Company
a Florida Corporation with Ite principal
office in Valdosta, Georg*.
By: Paul E. Colestock
Vies President