Patient Account Number - last four digits will change for each visit with exception of recurring accounts
Date treatment began or date of admission for in-patient (hospital) treatment
Date of the current statement
Guarantor or person responsible for payment of entire bill or portion of bill not covered by a third party or health insurance company
Payment amount expected from patient or guarantor. If empty, no payment is expected at this time
Date payment must be received to insure credit before next billing cycle
Type of service
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
Name of facility where services were provided or rendered
Phone number for Billing Customer Service or person handling this account
The patient name indicates the person who received the services.
This is your account number.
Insurance policy information on file.
The statement date is when your bill was printed and mailed to you.
Date your payment must be received by SRMH.
Date services were provided.
Summary of services provided.
Amount of charges for services.
Total Hospital Charges: Total cost of services; Total adjustments: Adjustments; Amount Pending by Insurance: Amount insurance has not paid as of statement date; Total Payments: Amount you have paid as of statement date; Total Due: Amount you owe as of statement date.
This section of your statement will contain important information regarding your account.
This section of your bill explains what information is required to authorize a credit card payment. Be sure to include your signature if paying by credit card. We accept Visa, MasterCard, Discover and personal checks.