Guarantor Information: Displays the name of the account guarantor, the patient account number, and the date the statement was generated.
Account Status: States the basic status of the account, including insurance coverage messages, payment plan information, and account urgency.
Payment Due: This is the total amount due at the date the statement was generated. A detailed breakdown is visible on the last page of the statement.
Online Payment: Shows the QuickPay option for online payments. You can make fast and easy online payments using the Pay Online link on our website or at Athena Health Portal.
Mail Payment: Mail your payment along with the payment coupon on page 1 to the address provided. Please note that this is a secured lockbox in Maine that our payments are routed to.
Questions?: Contact one of our Patient Account team members to discuss your balance and insurance information at 239-313-2517.
Patient Portal: Sign up for the patient portal at the web address provided on your statement to view statements online and enroll in paperless statements and bill pay.
Notes Section: Includes any accounts notes pertinent to your account, if applicable.
Payment Coupon: Displays payment due date, patient account number, amount due, and mailing address. Please make checks payable to Riverchase Dermatology.
Information Changes: Please check this box if you need to update your personal or insurance information. Indicate all changes in the “Patient Information” and “Insurance Information” sections at the bottom of page 2.
Frequently Asked Questions: A list of FAQs regarding your statement, balance, and payment information.
Information Changes: Please complete this section should you have any updated to your personal or insurance information. Remember to check the box notifying us of your updates on the payment coupon on page 1 (see item number 10).
Charge Summary Section: Outlines the total charges, total credits and payments, and remaining balance on the account as of the date listed on the statement.
Patient Name: States the name of the patient seen on the listed service date.
Provider Name: Lists the name of the provider who rendered services. Please note that if multiple providers were involved in your care, you may see charges from different providers on the same service date (e.g. A pathologist may examine your specimen in the lab, or a different provider may perform your wound closure after a procedure).
Service Location: Displays the location in which your services were rendered. Note that if our dermapathologist examined analyzed your tissue specimen, this will display the location of the lab. This may differ from the location where you were seen.
Date: This will show the service dates of all procedures along with the transaction dates of all monetary activity.
Description: Includes a general description of services rendered, as well as descriptions of transactions such as insurance payments, adjustments, and the reason for your remaining balance (e.g. Copay, Deductible, Coinsurance).
Charge Status: This states the insurance processing status (e. g. Processed, Ineligible, etc.)
Charges: Lists the total charge (before payment and insurance processing) of each service rendered.
Payments/Credits: Displays all payments, credits, and adjustments from all parties. Please note that these are displayed as negative dollar amounts.
Patient Balance: This column will list the remaining patient balance for each individual procedure.
Total Patient Balance: If multiple procedures and balances are displayed on your statement, you will see the sub-total of the balances in bold here.