How to Read a Statement

To help you better understand your billing statement for medical services rendered, we are including a numbered and annotated sample invoice that outlines the billing statement for you.

SAMPLE

  1. Make Checks Payable To: make check payment to the Emergency Group that provided the service at the hospital at which you were seen. Sample statement shows First Emergency Care Physicians.

  2. Addressee: the addressee is the responsible party for the bill and services rendered.

  3. Payment Options: there are four payment options available to you:
    –     securely pay online: https://www.patientonlinepay.com (formerly erstatement.com)
    –     pay by phone: (909) XXX-XXXX 24-hours a day (sample phone # shown in statement)
    –     pay by mail: mail payment with coupon, Client ID and Account # noted on check
    –     mobile quickpay: scan the QR code to pay with mobile Papaya QuickPay

  4. Remit To: the address location where to send a check in the mail.

  5. Email Inquiries: select the correct email below
    –     patient inquiries: patient@patientonlinepay.com
    –     insurance inquiries: insco@patientonlinepay.com
    –     attorney inquiries: chartswap.com

  6. Account No: patient account number.

  7. Patient Name: the patient who received medical tests and/or treatment services.

  8. Date: date of service(s) rendered (currently blank and not applicable).

  9. PS: provided service location within the hospital where tests and/or treatment services were rendered (currently blank and not applicable).

  10. Exam Code: exam type code used by the insurance company and health care providers, known as CPT code or common procedural terminology, for tests and/or treatment services provided (currently blank and not applicable).

  11. Service Description: description of service provided (currently no applicable service activity, instead the remaining balance due is indicated).

  12. Diagnostic Code: diagnostic code known as ICD-9 or ICD-10 (currently blank and not applicable).

  13. Charge Amount: amount billed for test and/or treatment service provided (currently blank and not applicable).

  14. Important Notice: please read message as it pertains to your bill!

  15. Pay Online: pay online at https://www.patientonlinepay.com, log in using Patient (Client), Account Number and patient’s date of birth.

  16. Emergency Physician Notice: this bill is for the Emergency Physician who is an independent doctor and is required to bill separately from the hospital.

  17. Account Balance: if you have a question about your bill, call 800-XXX-XXXX (sample #)

  18. Billing Inquiries: if you have a question about your bill, call 800-XXX-XXXX (sample #)