Patient Statement of Account 

Use the numbers and corresponding explanations below to locate important information for this statement.

Please call us at (757) 233-4500 if we can assist with any questions or concerns.  

 

1. Patient Name
2. Patient Account Number - last four digits will change for each visit with exception of recurring accounts
3. Date treatment began or date of admission for in-patient (hospital) treatment
4. Date of the current statement
5. Guarantor or person responsible for payment of entire bill or portion of bill not covered by a third party or health insurance company
6. Payment amount expected from patient or guarantor. If empty, no payment is expected at this time
7. Date payment must be received to insure credit before next billing cycle
8. Type of service
9. Charges incurred during out-patient visit, in-patient stay, or recurring instances of treatment; Please note:
   (a) The initial in-patient statement will show a summary of charges by department; a detail of charges is available on request by calling (757) 233-4500
   (b) The initial out-patient statement will show a detail of charges for the visit
   (c) Follow up statements will show a "balance forward" and will indicate any payments or adjustments made during the billing cycle
10. Name of facility where services were provided or rendered
11. Phone number for Billing Customer Service or person handling this account 

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