Forms & Billing
Payment Plan Requests
We accept requests for balances due over $100.00.
The orange link below will direct you to our secure patient vault
- Enter the general information found on your billing statement
- Enter your credit/debit card details
- Choose a Plan:
- PLAN A: Pay Over 2 Months
- PLAN B: Pay Over 4 Months
- PLAN C: Pay Over 6 Months
- Choose a Date:
- 15th of the Month
- 30th of the Month
- You will then be prompted to “Save Payment Info”
- We take the security of your payment information very seriously and will not process any payment plans outside of this portal.
- At our discretion, we will finalize your enrollment in the plan of your choice & your first payment will be automatically processed on the date of your choosing
- You will be emailed a receipt after each payment.
If your payment method is declined/rejected for any reason, & no attempt has been made to update your information with our office, you will no longer be eligible for a payment plan & your outstanding balance will become due & payable in full within 14 days. After 14 days, your account will be turned over to our collections company.
If you have any questions, or need to request a modification to an active payment plan, please email billing@ciscapulmonary.com
We’re always just a phone call away.
Our knowledgeable physicians can help you with anything you need.