Hospital Bill

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 home

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.