Secure Online Bill Pay

   
 

All information entered below should be as it appears on your last statement. Accounts that have a balance of $0.00 are not currently available online.

(This site works best in current versions of Google Chrome or Mozilla Firefox web browsers. If using Internet Explorer 10/11 you may need to add this site to the Internet Explorer compatibility view list.)

  *All Fields are Required
Patient/Guarantor Information
*Patient First Name:

*Patient Last Name:
*Patient Date of Birth: (mm/dd/yy)
Visit Information
*Patient Account/Guarantor Number:
 
Note - If you are entering your guarantor account number (Social Security number), enter it with the hyphens. Example - 123-45-6789. When using the patient account number (V plus 9 numbers), it must be entered with all digits including the zeros.
 
Contact Information
*Email Address:
*Email Confirm:
     
  If you have any trouble logging on or have other questions please call us at
1-855-264-4852.
     
  I have read the "Notice of Privacy Practices" and agree to the use and disclosure of information as stated in the document.
 
   
 

    Notice of Privacy Practices           Contact US         Copyright 2012 Great Plains Regional Medical Center