Outpatient Bill -- Description of Parts

1. Patient - Patient's name

2. Type Service - 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. Inpatient means the patient was admitted to the hospital.

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 patient visit.

5. Service Date(s): - The month in which the patient received the services listed on this bill.

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

Bill Date - The date this bill was printed.

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".
8. Charges/Payments: The charge amount for each type of service.

Estimated Insurance Coverage1 - If you have insurance, this amount will be the same as the amount in the CHARGE/PAYMENT column because we will not know the patient payment responsibility until the insurance company provides us that information.

Estimated Insurance Coverage2 - This column is usually blank.

Estimated Amount You Owe - If you have insurance, this amount will be zero because we will not know the patient payment responsibility until the insurance company provides us that information. If you do not have insurance, this is the amount due.
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.