|
 |
| Reading Your Statement |
Mouse over sections of the sample billing statement to see descriptions. 
| Statement Message - The statement message contains important information about your bill. It oftentimes discusses important insurance information as well as payment deadlines. |
| Current Account Balance - This is the total balance still due by your carrier for the account number referenced on this statement. |
| Account Number - This number represents the date of service for your visit. A different account number is assigned to each visit. |
| Account Number - This number represents the date of service for your visit. A different account number is assigned to each visit. |
| Payment - Payment can be made using MasterCard, Discover, Visa or American Express credit/charge cards. Complete the requested information and return the top portion of the statement in the envelope provided. If payment is made by check, please enclose a check with your account number visibly listed on the check. |
| Service Location - The service location is the location where service was provided. In some instances you may see a service location name listed that you did not visit. This is because some services are billed under another facility. |
| Name/Address Corrections - To correct your name and address information, complete the form on the reverse side of the statement. |
| Transaction Detail - This is a list of all payments and adjustments posted to this account as of the statement date. |
| Amount Past Due - Unpaid balance that is past the due date. |
| Statement Date - Date your statement was created. Any payments posted after this date will not be reflected in the Current Account Balance. |
| Service From - Beginning date of service for this account. |
| Service Through - Ending date of service for this account. |
| Amount Enclosed - Use this space to write the dollar amount of the payment enclosed. |
| 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. |
| Addressee - The name and address of the person financially responsible for the bill. |
| Name - The name of the patient. |
| Amount Due - This is your total balance due for the account number referenced on this statement. |
| Account Number - This number represents the date of service for your visit. A different account number is assigned to each visit. |
| Addressee - The name and address of the person financially responsible for the bill. |
| Amount Due - This is your total balance due for the account number referenced on this statement. |
| Amount Enclosed - Use this space to write the dollar amount of the payment enclosed. |
| Amount Past Due - Unpaid balance that is past the due date. |
| Current Account Balancee - This is the total balance still due by your carrier for the account number referenced on this statement. |
| Name - The name of the patient. |
| Name/Address Corrections - To correct your name and address information, complete the form on the reverse side of the statement. |
| Payment - Payment can be made using MasterCard, Discover, Visa or American Express credit/charge cards. Complete the requested information and return the top portion of the statement in the envelope provided. If payment is made by check, please enclose a check with your account number visibly listed on the check. |
| 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. |
| Service From - Beginning date of service for this account. |
| Service Location - The service location is the location where service was provided. In some instances you may see a service location name listed that you did not visit. This is because some services are billed under another facility. |
| Service Through - Ending date of service for this account. |
| Statement Date - Date your statement was created. Any payments posted after this date will not be reflected in the Current Account Balance. |
| Statement Message - The statement message contains important information about your bill. It oftentimes discusses important insurance information as well as payment deadlines. |
| Transaction Detail - This is a list of all payments and adjustments posted to this account as of the statement date. |
|
|
