Inpatient Bill -- Description of Parts

1. Patient - Patient's name

2. Type Service -Inpatient means the patient was admitted to the hospital. Outpatient usually means services you receive in one day/24 hours (e.g. clinic visits, lab tests, trip to emergency room). There may be times when a patient stays in the hospital more than 24 hours for observation; this is still considered outpatient.

3. Insurance(s) - This is the type of insurance coverage our records reflect for this patient. We will submit a claim for payment to this insurance company. If our information is incorrect, please notify Patient Financial Services immediately at 924-5377 or 1-800-523-4398.

4. Account No.: - The identification number for this specific period of time the patient stayed in the hospital.

5. Service Date(s): - The date(s) when the patient received the services listed on this bill.

Bill Date - The date this bill was printed.

6. "B" means this is the first time the bill has been produced.

7. Summary of Charges, Payments, and Adjustments: A summary of the type of medical services received. For example, all lab tests will be summarized under, "CLINICAL LAB". All payments and adjustments will also be summarized here.
8. Charges/Payments: The charge amount for each type of service listed.

Estimated Insurance Coverage1 - If you have insurance, this is the estimated amount your primary insurance company will pay. If you do not have insurance, this column will be blank.

Estimated Insurance Coverage2 - If you have a secondary insurance company, this column may list an estimated amount that your secondary insurance may pay.

Estimated Amount You Owe - The amount you owe at this time. If you have insurance, your insurance company determines your benefits. Therefore, this amount could change after insurance payment.
9. Balance Due Now - The amount you owe at this time.
13 The name and address our records reflect as the person responsible for paying this bill.
15. For credit card payment: You may pay this bill by credit card by either checking this box and filling out the form on the back of the page, or by calling our Customer Service Department at 924-5377 or 1-800-523-4398.