Itemization & Patient Billing Statements

You will receive a complete itemization of hospital services, followed by a statement of account which will list insurance payments and indicate the outstanding balance. For help with your bill, or for statement copies, contact the billing department where services were received.

NOTE: Our clinics can provide an itemized statement upon request.

Interactive Bill Demonstration

Choose Your Bill

Hospital Bill - Insurance and Contact Information

Commented view of hospital bill
  • Name of Facility where services were provided or rendered
  • Address of Intermountain Healthcare's official site, where additional information and assistance can be found
  • Guarantor or person responsible for payment of entire bill not covered by a third party or health insurance
  • Name of Patient
  • Description and date of services received
  • The date the statement was created
  • This is the account number given for the services rendered. The account number will be different for each visit

Hospital Bill - Insurance and Contact Information

Commented view of hospital bill
  • Name and address of insurance company being billed for this account
  • The date the bill was sent to the insurance company
  • The policyholder's name for the primary insurance
  • Secondary insurance (if any) given at the time of registration
  • The policy number for the primary insurance company

Hospital Bill - Services & Billing Details

Commented view of hospital bill
  • Date service was performed
  • This is an internal finance code
  • Describes both clinical services and billing activity
  • This column will have different codes that are used to bill insurance companies
  • Shows number of items charged to account, as well as number of credits applied
  • Amount of the charge or credit being applied for that item
  • Total balance of all charges on account
  • Any payments or adjustments made on the account as of the itemized statement date
  • Balance of account, as of the date the itemized statement was created

Patient Account Statement - Hospital & Contact Info

Commented view of patient account statement
  • Name of facility where services were provided or rendered
  • The date the current balance of the account is due
  • The current amount due. If no amount is showing, then no amount is currently due
  • This is the account number given for the services rendered. The account number will be different for each visit
  • Guarantor or person responsible for payment of the entire bill or portion of bill not covered by third party or health insurance company
  • The return mailing address for payments made by check or credit card

Patient Account Statement - Services & Billing Details

Commented view of patient account statement
  • Transaction date
  • Transaction description
  • Transaction amount
  • The messages here let you know what is happening with your account. Follow any instructions to assist with getting your account paid in a timely manner
  • The name and phone number of your patient account representative or office
  • The date this statement was created
  • Name of patient
  • The date of service or admission to the hospital
  • The type of service received

Patient Account Statement - Insurance Info

Commented view of patient account statement
  • Name of the insurance company billed for this account
  • Secondary insurance information
  • Name of facility where services were provided or rendered
  • This is the account number for the services rendered. This number corresponds to the Account Number on the Hospital Bill
  • The total of all charges on the account
  • Balance of the account, as of the date the statement was created
  • The current amount due. If no amount is showing, then no amount is currently due
  • URL of Intermountain Healthcare's website, where you can find additional assistance and contact information

Intermountain Medical Group Bill - Clinic & Contact Information

Commented view of intermountain medical group bill
  • Name of facility where services were provided or rendered
  • The date the current balance of the account is due
  • The current amount due. If no amount is showing, then no amount is currently due
  • The number assigned to the patient's account
  • This is the date this statement was created
  • Guarantor or person responsible for payment of the entire bill or portion of bill not covered by third party or health insurance company
  • The return mailing address for payments made by checks or credit cards

Intermountain Medical Group Bill - Services & Billing Details

Commented view of Intermountain Medical Group Bill
  • Name of Patient
  • Invoice Number for this billing
  • This is the account number given for the services rendered. The account number will be different for each visit
  • The date the account was created. If inpatient, the date of admission
  • The type of service rendered
  • The amount billed
  • The date the payment or adjustment was made
  • The type of payment or adjustment made to the account
  • The amount of the payment or adjustment

Intermountain Medical Group Bill - Payment Info

Commented view of Intermountain Medical Group Bill
  • Amount currently due
  • Amount due on charges 30 days past due
  • Amount due on charges 60 days past due
  • Amount due on charges 90 days past due
  • Amount due on charges 120 days past due
  • Total amount due on the account
  • Billing offices contact information

Patient Financial Services Statement � Contact Info

Commented view of Patient Financial Services Statement
  • Name of dept where facility accts with self pay balances are referred
  • PIN number for Online Bill Pay
  • Pay the total amount due by this date
  • Total amount due as of the statement date
  • The Patient Financial Services account number
  • Guarantor or person responsible for payment
  • The remittance address for payments made by mail

Patient Financial Services Statement � Payment Plan Info

Note: you will see this section if you have accounts on a mail-in payment plan

Commented view of Patient Financial Services Statement
  • Total balance due for the payment plan as of statement date
  • Amount due for the payment plan as of statement date
  • Amount of interest accrued on the payment plan as of statement date
  • Past due amount for the payment plan

Patient Financial Services Statement � Accounts Not on a Payment Plan

Note: you will see this section if you have new or existing accounts not on a mail-in payment plan

Commented view of Patient Financial Services Statement
  • Facility account number
  • Name of facility where services were provided
  • Name of patient
  • Type of service received
  • The date of service or admission to the hospital
  • The balance of the facility account, as of the statement date

Patient Financial Services Statement � Payment Info

Note: you will see this section if you have new or existing accounts not on a mail-in payment plan

Commented view of Patient Financial Services Statement
  • Amount currently due for accounts not on a payment plan
  • Amount 30 days past due for accounts not on a payment plan
  • Amount 60 days past due for accounts not on a payment plan
  • Amount 90 days past due for accounts not on a payment plan
  • Amount due for the payment plan
  • Total amount due as of the statement date
  • Patient Financial Services contact information
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