PAYMENT PLAN (Select the Accounts to Include in a Payment Plan)

You have the ability to setup scheduled payment arrangements with automatic payment from your credit card or bank account.
Choose the accounts below you wish to include…

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Patient Responsible Party Account # Account # Claim Number Date of Service Balance Include
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  • Total:
  • {{::others.TotalBalanceAmount|currency}}
  • {{others.TotalPlanAmount|currency}}