Fair Patient Billing Act Notification
Concerning Out-Of-Network Providers
In compliance with the "Fair Patient Billing Act" concerning out-of-network providers, please be advised:
- You may receive separate bills for services provided by health care professionals affiliated with Memorial.
- Some health care professionals may not be participating providers in the same insurance plans and networks as Memorial.
- You may have a greater financial responsibility for services provided by health care professionals at Memorial who are not under contract with your health care plan.
- You should direct questions about coverage or benefit levels to your health care plan and certificate of coverage.
Memorial Medical Center would further like to ensure that your hospital bills provide the following information:
- The date(s) of service (admit date and discharge date are indicated on the front of your statements, as well as on the back under “Account Summary.”)
- A brief description of the service(s) provided. Please refer to the back of your Memorial Medical Center statement under “Summary of Charges.”
- The amount owed
- Hospital contact information for addressing billing questions: Patient Financial Services, 217-788-3800 or 800-562-2829.
- Notice that itemized bills are available upon request.
- A statement that, if you are uninsured, you may be eligible for financial assistance under the terms and conditions the hospital offers to qualified patients. For more information, contact Patient Financial Services at 217-788-3800 or 800-562-2829.
If you would like to ask questions, dispute your account, request an itemized statement, need assistance in making payment arrangements, or need to speak with a patient financial services representative, please call 217-788-3800 or 800-562-2829. For your convenience, you may also access your billing advocate online by emailing firstname.lastname@example.org.
Memorial Medical Center's patient financial representatives are available Monday through Friday from 8:00 a.m. to 4:30 p.m. (except holidays). You may also submit your inquiries by mailing your request to:
701 N. First Street
Springfield, Illinois 62781-0001
Attn: Patient Financial Services.