Payment
FAQ
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What is an Explanation of Benefits (EOB)?

Pay your statement now

Date of birth

Date of service

MM/DD/YYYY

PAY YOUR STATEMENT NOW

Statement ID:

Statement Date:

Statement Amount:

Selected Pay Amount:

Select your payment option

Statement ID:

Statement Date:

Statement Amount:

Selected Pay Amount:

Full payment

Payment plan

$ Enter initial amount

(Initial payment amount must be in between $ and $ for this statement)

Remaining balance applied to payment plans: $

Sign up

Sign up to view all your statements, visit information, all past transactions and payment plan details

Enter user email

Enter mobile phone number 1XXXXXXXXXX

Enter patient date of birth MM/DD/YYYY

Contact Admin

Enter Card Details

All fields must be filled to proceed

Select Plan Duration

Statement ID:

Statement Date:

Statement Amount:

Selected Pay Amount:

Select Duration (in months)

Note:

Based on selected duration initial amount and carry forward amount to the plan might slightly change.

Monthly installment payments will be automatically processed from your card.

Initial amount: $

Amount carry forward to the installments: $

Monthly installment amount: $

By submitting, I agree to the Terms of Service and Privacy Policy.

Proceed

Find my statement Pay now Pay $ Initiate payment plan Proceed Cancel

Terms of Service and Privacy Policy.

Select Your Option to Proceed

Please click "SUMMARY & PAYMENT OPTIONS" to proceed with payments

Summary & Payment Options

Please enter patient date of birth and click on "DOWNLOAD STATEMENT" button

Date of birth MM/DD/YYYY

Please Note That ...

Click to view/download the invoice mailed on to the address on file for this case.

Download statement

Payment Status

Payment Receipt

Transaction Reference ID

Transaction Date

Card Number

....

Transaction Amount

Details

Reference ID

Previous Due

Transaction Amount

Current Due

Please note that it will take 3 - 5 business days for the payment to reflect on the case

Print

Select Plan Duration

Statement ID:

Statement Date:

Statement Amount:

Selected Pay Amount:

Select Duration (in months)

Note: Based on selected duration initial amount and carry forward amount to the plan might slightly change.

Initial amount: $

Amount carry forward to the installments: $

Monthly installment amount: $

Initiate payment plan Cancel

Payment Plan Details

Success: Payment plan initiated successfully!

Statement/ Case/ Visit ID

Plan ID

Plan Status

Initiated Date

Duration

Months

Last Installment Date

Installment Amount

$

Total Amount

$

Initial Amount

$

Payment Plan Amount

$

Note: Monthly installment payments will be automatically processed from your card.

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