1. Personal Family Statement: This indicates the type of account these visits are associated with.
  2. Account Number: This number is unique to each patient.

    Responsible Party: This person is financially responsible for paying the account balance, and may be a different person than the patient. You may also hear this person referred to as a “guarantor”.

    Statement Date: You’ll receive a statement once a month if there is patient responsibility

  3. In this section you will find information on how to sign up for MyChart, our secure online health management tool.

  4. Your full account balance and due date will always appear right on the front of your bill. If you’re unable to pay your balance in full, payment arrangements can be made to keep your account in good standing.

  5. Messages about your account status may appear here.

  6. On every statement, we give you a way to ask a specific question to a billing representative. You can call or email us at any time.

  7. Be sure to write how much you are paying when you submit the bottom portion of the statement with your payment. If for some reason you cannot make your minimum payment by the due date, be sure to let us know to avoid defaulting on your balance owed. Financial assistance options are available. Visit us online or call to learn more.

  8. This section shows the detail for each of your visits with a patient responsibility. Your visit numbers are unique to your provider and facility charges. This means you may have multiple visit numbers for each date of service.

  9. You’ll see a summary of charges, payments and the amount you owe on the last page of every monthly statement. All of the columns will add up to the charges and payments you see in the detail section. In addition to the account balance (the total amount you owe), you’ll see the amount due on this page as well as the front page of your statement.

View example statement