University of Pennsylvania Health System

Hospital Billing

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.

Back to Patient Billing

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.