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How To Read Your Bill

1. Amount Due Now
This is the current amount due for the statement. When applicable, Payment plan amount due (+) new visits and/or previous visits not on a payment plan amount due. Take note this amount may be different than your total balance due.

2. Prompt Pay
Visits in a first notice status may receive an automatic 10% prompt pay discount when paid in full by the due date. If you have received Financial Assistance this discount may no longer be available.

3. Guarantor Name
Patient or the Person responsible for the Patient.

4. Guarantor Number
Unique identifier for the Patient or the Person responsible for the Patient.

5. Bill Summary
This window includes a summary of the patient's total balance, payment plan amount due (when applicable) and the amount due now.

6. Payment Options
Options to pay your bill by phone and online 24/7, includes a required online Access Code for secure login.

7. Payment Plans
General information about setting up a payment plan and/or adding additional visits to a current payment plan.

8. Financial Assistance
General guidelines for applying for financial assistance, see form on the reverse side of page one.

9. Your Next Steps
General assistance message on what the guarantor should do next.

10. Remit Coupon
Includes a summary of the bill, due date, remittance (secure envelope included), the amount you paid and a paperless billing enrollment checkbox. Paperless enrollment form and Credit Card voucher on the reverse side.

11. Visit Accounts on a Payment Plan
This window references visits currently established in a payment plan, a summary of the number of payments & balance remaining, and the monthly amount due.

12. New Accounts and/or Visits not on a Payment Plan
This window references new facility visits and/or previous facility visits not established with a payment plan, and the details of those visits.

13. Insurance Billed
Insurance information provided by the guarantor at the time of service.

14. Visit Details
This section details new and/or previous visit charges not established with a payment plan. Details providing the visit’s number, date of service, patient’s name, status (for example first, second, third or final notice), description of services, facility charges, adjustments, the amount due and when applicable a prompt pay discount.

15. Total Facility Charges
This amount represents the sum of each visit not established on a payment plan, plus your total payment plan balance when applicable.

16. Federal Poverty Guidelines (reverse side of page 1)
Highland District Hospital has a financial assistance program for guarantors who need assistance resolving their hospital bills.

17. Remit Stub's Paperless Billing Enrollment From
This section has recently been updaed, you can now scan the QR code on the back of the remit stub to enroll in paperless billing. You must have a valid street address for all delivery options. To protect your personal health information, please use a private email address and/or phone number, that only you or someone authorized by you has access to.

18. Remit Stub's Credit Card Voucher and Autopayment Authorization Forms
Guarantors can use this form to submit a credit, debit or HSA card payment by mail, and setup a payment plan by authorizing auto-payments. Please call or go online if you want to setup auto-pay by a checking or savings account.