Medical Payment Plan Template

My current patient account balance is as of date.

Medical payment plan template. The document may be used for a wide range of services from a standard doctor s visit to voluntary or involuntary surgery. These plans benefit both the medical practitioners and their patients. Patient payment agreement forms are for those people who are either patients themselves or are a parent sibling or friend of a patient who s willing to pay for the medical bills. Payment plan balance minimum payment amount under 100 25 per month 100 200 35 per month 201 300 45 per month 300 or above 50 per month 2.

Work with you to resolve your balance. A medical payment plan usually does not have interest attributed to the amount owed unless the balance goes unpaid. Medi cal monthly premium payments may be required of some children who have transitioned from the healthy families program or have applied for medi cal. Medical payment plan templates according to research the number of patients that are using medical payment plans ar increasing nowadays.

Sample patient payment installment plan in doc format comes handy if some patient is unable to pay the doctor s fees or hospital charges and wants to repay this debt in installments. Premiums are based on a family s income and family size. Don t forget to share this picture with. This is common when an amount is too much to pay for a debtor in a single installment.

This is to make sure that they know what treatment the patient has undergone and how much they ll have to pay along with the payment plan. If you are required to pay a monthly premium for your medi cal you will receive a billing statement in the mail each month. Patient s medical bill tracker track your incoming medical bills insurance payments and out of pocket payments and this template will show you the balance owing. For creating a payment plan templates can be used to schedule installment payments keep track of due dates and manage payments over time.

This template includes terms and also installment contract sample that specifies the payment details in advance. The medical payment plan agreement is for any patient that has received health care services and agrees to have their balance due paid over a period of time. To add there are also verification of medical payment plan templates that displays the standard format for verification of medical plans. Formats medical payment plan agreement template excel word pdf doc xls blank tips.

Listed below are our payment plan options. Each template is fully customizable and designed to look professional while saving you time. A payment agreement outlines an installment plan to repay an outstanding balance that is made over a given time frame.