Understanding Your Bill

Hospital Bill - Insurance and Contact Information

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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