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Patient Billing: Understanding Your Statement/Bill
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Patient
Billing
Understanding
Your Statement / Bill
We've
recently updated our bill to make it easier to understand. This sample
statement explains at a glance the components of the new bill. Mouse
over the highlighted numbers to view descriptions.
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Text
Descriptions of Bill
- Name of Hospital - Facility where services were rendered.
- Addressee - The guarantor name and address appears here.
- Remit To - The address where you should mail your payment. Please detach and
include the top portion of the statement with your payment to ensure
proper credit to your account.
- Credit Card
Payment - If paying by credit card, use this area to complete
the necessary information, including, type of credit card, card number,
expiration date, amount you are paying, and signature. We accept American
Express, Discover, MasterCard or Visa.
- Statement
Date - Date your statement was created. Any payments posted after
this date will not be reflected in the current Balance Due.
- Pay This Amount - The amount for which you are responsible.
- Due Date - Date your payment must be received.
- Account # - The first 9 digits is your medical record number and the last 4
digits refer to the visit for which you are being billed on this statement.
- Show Amount
Paid Here - Write the amount you are paying toward this bill.
- Comment Area - Read this area for important information and notices regarding your
account.
- Patient Name - Name of the person who received service.
- Admit/Service
Date - Date of service for this account.
- Discharge
Date - Date of release from the hospital.
- Service - Type of service for which you are being billed.
- Total Charges
- Total amount billed for this visit.
- Total Insurance
Payments - Total payments received from your insurance company.
- Total Patient
Payments - Total amount received from the patient.
- Total Adjustments - Preferred insurance adjustment for which you qualify.
- Balance Due - The amount owed that reflects the total charges less any payments
made by you and/or your insurance company as of the statement date.
Any payments posted after the statement date will not be reflected
in the current balance due.
- Balance Last
Statement - Balance from your last statement.
- Payments Since
Last Statement - Sum of all payments received since your last
statement.
- Patient Business
Services Contact Information - Customer Service contact information,
including hours of operation, mailing address, phone numbers and e-mail
address.
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Name
of Hospital
Facility where services were rendered. |
Addressee
The guarantor name and address appears here. |
Remit
To
The address where you should mail your payment. Please detach and include
the top portion of the statement with your payment to ensure proper credit
to your account. |
Credit
Card Payment
If paying
by credit card, use this area to complete the necessary information, including,
type of credit card, card number, expiration date, amount you are paying,
and signature. We accept American Express, Discover, MasterCard or Visa. |
Statement
Date
Date your statement was created. Any payments posted after this date
will not be reflected in the current Balance Due. |
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Pay This Amount
The amount for which you are responsible.
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Due
Date
Date your payment must be received. |
Account
#
The first 9 digits is your medical record number and the last 4 digits
refer to the visit for which you are being billed on this statement. |
Show
Amount Paid Here
Write the amount you are paying toward this bill. |
Comment
Area
Read this area for important information and notices regarding your account. |
Patient
Name
Name of the person who received service. |
Admit/Service
Date
Date of service for this account. |
Discharge
Date
Date of release from the hospital. |
Service
Type of service for which you are being billed. |
Total
Charges
Total amount billed for this visit. |
Total
Insurance Payments
Total payments
received from your insurance company. |
Total
Patient Payments
Total amount received from the patient. |
Total
Adjustments
Preferred insurance adjustment for which you qualify. |
Balance
Due
The amount
owed that reflects the total charges less any payments made by you and/or
your insurance company as of the statement date. Any payments posted after
the statement date will not be reflected in the current balance due. |
Balance
Last Statement
Balance from your last statement. |
Payments
Since Last Statement
Sum of all payments received since your last statement. |
Patient
Business Services Contact Information
Customer Service contact information, including hours of operation,
mailing address, phone numbers and e-mail address. |
Account
#
This is your account number. The first 9 digits is your Medical Record
Number and the last 4 digits refers to the visit for which you are being
billed on this statement. |
Statement
Date
This is the date your statement was created. Any payments posted after
this date will not be reflected in the current balance due. |
Due
Date
This is the date by which your payment must be received. |
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