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Sample Billing Statement


You are viewing a sample of the new MetroHealth combined billing statement.  Hover/mouse over question marks for detailed explanations of your bill.

ACCOUNT #: This number is unique to each visit. Use this number when speaking to or corresponding with our billing representative to quickly identify the date of service about which you are inquiring.

Please Note: You will see a different account number for your Physician Services and Hospital Services. This date represents the date of service; inpatient stays list both admission date and discharge date.
INSURANCE PMTS/ADJS: This represents payments and adjustments that have been received from your insurance company and applied to your account.

PATIENT PMTS/ADJS: This represents payments you have made on your account and/or any adjustments MetroHealth has applied to your account.

INSURANCE BALANCE: This represents the balance that has been billed to your insurance company. Insurance payment is pending.

PATIENT BALANCE: This represents the balance that the addressee/guarantor is responsible for paying on this account.
GUARANTOR NO. and MEDICAL RECORD NO. : These numbers are unique to each patient.

PAY THIS AMOUNT (Also labeled as BALANCE DUE): The amount due in full to MetroHealth. You can mail a payment, pay online or through MyChart. If you do not pay in full, please call our Billing Office, so that your account is not considered past due.

BILL DATE: The date this statement was generated. You will receive a monthly statement as long as you have a self-pay balance with MetroHealth.

CURRENT INSURANCE: Primary insurance coverage on record for you as a patient. It may not be effective for all dates of service shown on this statement. If this is not your current insurance, please call our Billing Office immediately.
ONLINE PAYMENT CODE: This number is unique to this statement and will change each month. Use this number the first time you register to make online payments. You can mail a payment, pay online or through MyChart.
Call this number to reach a billing representative who can answer your billing questions.
ADDRESSEE: The name to which this statement is addressed represents the person responsible for any balance that is the patient responsibility. This person is also known as the guarantor.
© Copyright 2002 - The MetroHealth System|2500 MetroHealth Drive|Cleveland, OH 44109|(216) 778-7800|All Rights Reserved.
  • © Copyright 2002 - The MetroHealth System
  • 2500 MetroHealth Drive|Cleveland, OH 44109|(216) 778-7800
  • All Rights Reserved.