To view an explanation of your bill, move your pointer over the numbered red boxes.
*If you received services at Pennsylvania Hospital or Penn Presbyterian Medical Center, you will receive a copy of this bill with the name of the hospital you visited on top.
- 1. Patient Name
- 1. Patient Name -
Your name should be in this box. If your name is misspelled, please notify us so we may correct the error.
- 2. Service Date
- 2. Service Date -
This is the date the service was provided.
- 3. Service End
- 3. Service End –
This is the date the service ended.
- 4. Last Statement Date
- 4. Last Statement Date –
This is the date of the last bill we sent you.
- 5. Account Number
- 5. Account Number –
This is your billing number. Please note that it is not your medical record number, and that it changes with each visit.
- 6. Return Address
- 6. Return address –
This is where the bill payment should be sent.
- 7. Statement of Account
- 7. Statement of Account –
This is the date your bill was produced by our system.
- 8. Transaction Date
- 8. Transaction Date –
This column lists dates you received tests or other services.
- 9. Description
- 9. Description –
This column lists the tests and other services you received while at the hospital.
- 10. Amount
- 10. Amount –
This column lists the fees for each test and service.
- 11. Estimated Insurance Due
- 11. Estimated Insurance Due –
This is an estimate of the amount that your insurance company will pay.
- 12. Total Patient Credits
- 12. Total Patient Credits –
This summarizes the payments received on your account at the time this bill was produced.
- 13. Account Balance
- 13. Account Balance –
This states the total amount that you owe the hospital as of this billing.
- 14. Statement Message Field
- 14. Statement Message Field –
This field contains important information regarding your bill.
- 15. Pay This Amount
- 15. Pay This Amount –
This is the amount that you owe the hospital as of this billing.
- 16. Due By
- 16. Due By –
This is the date your payment is due by.
- 17. Credit Card Payment Field
- 17. Credit Card Payment Field –
Use this area if you wish to pay by credit card.
- 18. Amount Paid
- 18. Amount Paid –
Fill in the amount of money that you are enclosing when you pay this bill.
- 19. Change of Address Field
- 19. Change of Address Field –
Please check this box and indicate any change(s) in your address on the back of the bill.
Need an appointment? Request one online 24 hours/day, 7 days/week or call 800-789-PENN (7366) to speak to a referral counselor.