We've recently
updated our bill to make it easier to understand. This sample
statement explains at a glance the components of the new bill. Mouse
over the highlighted numbers to view descriptions.
Explanation of Page 1 of the Lee Memorial Health System Invoice
1. Patient Name: Name of the person who received service.
2. Guarantor: The name and address of the person financially
responsible for the bill.
3. Remit To: The address where you should mail your payment. Please
detach and include the top portion of the statement with your
payment to ensure proper credit to your account.
4. Credit Card Payment: If paying by credit card, use this area to
complete the necessary information, including, type of credit card,
card number, expiration date, amount you are paying, and signature.
We accept MasterCard, Visa, Discover, and American Express.
5. Admission Date: Date of service for this account.
6. Statement Date: Date your statement was created. Any payments
posted after this date will not be reflected in the current Balance
Due.
7. Current Balance: Balance on the account the date the statement
was created.
8. Account Number: The number assigned to this specific date of
service.
9. Discharge Date: Date of release from the hospital.
10. Please Pay This Amount: The amount for which you are
responsible.
11. Payment Due By: The date your payment must be received in our
office.
12. Enter Amount Paid: Write the dollar amount of the payment
enclosed.
13. Service Location: Facility where services were rendered.
14. Total Charges: Total amount billed for the services provided.
15. Transaction Detail: Charges, payments, and adjustments posted to
the account since your last statement.
16. Messages: Informational messages regarding the status of your
account.
17. Previous Balance: Balance from your previous statement.
18. Payments /Other Adjustments: Sum of all payments and adjustments
posted since your last statement.
19. Central Business Office Contact Information:
Customer Service
contact information including phone numbers, e-mail address, and
mailing address.
Click here to review page 2 of the LMHS
Statement / Bill
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