Forms

Forms

Billing Questions

We're happy to help with your billing questions. Please see the Billing and Insurance page on our website first. If your questions are not answered there, submit your inquiry below and a billing specialist will respond by phone within three business days, between the hours of 8 am and 4 pm.

If you'd prefer to contact us by phone, call HealthEast Patient Financial Services at 651-232-1100 or 866-770-6412 (toll-free). To pay a bill online, please go here.

*Required fields

Requestor information

First name*
Enter the requestor's first name.

Last name*
Enter the requestor's last name.

E-mail address*
Please enter a valid e-mail address

Patient information

*

Select if the patient is the same or different as the requestor.

First name
Invalid Input

Last name
Invalid Input

Patient date of birth*
Enter a valid date of birth.

mm/dd/yyyy

Relationship to patient*

Enter your relationship to patient.

Specify your relationship to the patient.

Statement date*
Enter your statement date.

mm/dd/yyyy

Account number*
Invalid Input

Select a location*
Select a clinic.

Provider name*
Enter your provider's name.

Health Insurance
Invalid Input

Contact information

Please let us know the best phone number and time at which to reach you.
Preferred*
Enter a valid phone number.


xxx-xxx-xxxx

Alternate
Enter an alternate phone number.

xxx-xxx-xxxx

Preferred time*
Select your preferred appointment time.

Billing question

Enter your question*
Enter a reason for your inquiry.