Patient Accounting
      Call 1-855-665-2970
  Monday-Friday 8:00am to 5:00pm
 




Card Number:
 3 Digit Code:
Signature:
 Exp Date:
Service Date
//
Patient Name
Amount Paid
$______.___
Amount Due
$
Account Number


Send Payment Stub to:




ADVOCATE BROMENN MED CTR
PO BOX 801734
KANSAS CITY, MO 64180-1734
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$
PROMPT PAY DISCOUNT -
WHAT YOU OWE $
PATIENT NAME
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ACCOUNT NUMBER
SERVICE DATE(S) //
TOTAL CHARGES $
TOTAL ADJUSTMENTS +
TOTAL ADJUSTMENTS -
TOTAL PAYMENTS -
WHAT YOU OWE $
PROMPT PAY DISCOUNT -
WHAT YOU NOW OWE $
Primary:
Secondary:
If you have any questions concerning your account, please call us between the hours of 8:00am and 5:00pm, Monday to Friday at 1.855.665.2970
Thank you for choosing Advocate BroMenn Medical Center as your healthcare provider of choice. We have filed your claim with your medical insurance. For questions about your bill, to pay your balance, or to set up a payment plan, please contact our office. Financial Assistance may be available to those who qualify.