I am a patient.

Billing and Payment Questions

1. I received a bill/statement that I believe is incorrect. What do I do?

Please call the customer service phone number located on your statement/bill and one of our patient account representatives will be happy to assist you. If you received a statement requesting necessary insurance billing information, please complete one of the forms below.

2. I received a duplicate bill/statement. What do I do?

3. How do I request a copy of my bill?

Please call the customer service phone number located on your statement/bill and one of our patient account representatives will be happy to assist you. If you do not have a statement/bill or are having trouble locating the toll-free customer service number, you can dial the main number for the hospital where you were seen and they will be able to assist you.

4. Can I pay my bill online?

On most statements, there is a web address, which will take you to a payment portal. If you are unable to locate the web address, please call the customer service phone number on your statement for assistance.

Financial Assistance Questions

1. Are payment plans available for paying my bill?

Please call the customer service phone number located on your statement/bill and one of our patient account representatives will be happy to assist you and can explain the payments options available.

2. How do I apply for Charity/Financial assistance or inquire about my application?

Please call the customer service phone number located on your statement/bill and let them know you are interested in learning more about the hospital's charity/financial assistance program.

3. I received a letter from Parallon about my eligibility for Medicaid or another state and federal program. I would like additional information.

Please call and we will be happy to assist you. 866-299-4633, ext. 2817.

Medical Records Questions

1. How do I request a copy of my medical records?

To request a copy of your medical records, please call the hospital or practice where you received treatment. If you are not the patient, you must have a Release of Information form completed and signed by the patient. The hospital or practice can provide the Release of Information form as well.

2. I am an attorney and need medical records for my client.

Please contact the hospital where the patient was treated and ask to speak with their medical records department.

Patient Forms

Please complete one of the forms below if you received a letter requesting more insurance billing information.

Motor Vehicle Accident Patient Form
Click here to access an online form where patients can provide additional information regarding a motor vehicle accident claim.

Workers’ Compensation Patient Form
Click here to access an online form where patients can provide additional information regarding a workers’ compensation claim

Still have a question?

Please complete the form below and we will be in touch with you soon.

* required field

Patient First Name *

Patient Last Name *

Patient Date of Birth

Month

Day

Year

Email Address *

Phone Number *

Facilty/Hospital where patient received services *

Approximate Date of Service

Month

Day

Year

How may we help?

** Please Note: general internet communication is inherently not secure.

For this reason, we highly recommend that data considered confidential or private in nature not be submitted on this form. (e.g., social security numbers, diagnosis information, credit card numbers, etc.)