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Synthetic data
RCM · Live template preview
Patient payment portal
Stripe-powered statements with payment plans and good-faith estimates.
L
Lumen HealthBillingLila Hamasaki · MRN 88-771-2204
Total balance due
$74.60across 3 statements
Plan
BCBS IL · PPO Bronze
Deductible YTD
$1,840 / $3,000
OOP YTD
$2,182 / $7,500
Group
GRP-7710
Member ID
XJB***6789
YTD paid
$413.00
| Service | Date | Amount | Status | |
|---|---|---|---|---|
Office visit Dr. Adeyemi · Lila · CPT 99214 | Apr 15, 2026 | $37.70 | Due | |
Lab panel — CMP, Lipid, A1C Quest Diagnostics · Lila · CPT 80053·80061·83036 | Apr 19, 2026 | $19.30 | Due | |
Pediatric well-check Dr. Park · Mia (8) · CPT 99393 | Apr 22, 2026 | $0.00 | Paid | |
Telehealth follow-up Dr. Adeyemi · Lila · CPT 99213 | Mar 22, 2026 | $17.60 | Past due | |
Specialist visit — Cardiology Dr. Voss · Lila · CPT 99244 | Feb 18, 2026 | $44.00 | On plan | |
MRI L knee w/o contrast Bay Imaging · Lila · CPT 73721 | Jan 20, 2026 | $144.00 | Paid | |
Annual physical Dr. Adeyemi · Lila · CPT 99396 | Dec 04, 2025 | $0.00 | Paid |
Selected to pay
$74.60
3 statements
Payment plan
Payment method
PCI DSS · processed via Stripe
RCM · Patient financial services
Self-pay collections & payment plan health
What patients are paying, on what plans, and where balances are getting stuck.
Payment method mix
Card on file$284k
One-time card$188k
ACH$92k
Apple/Google Pay$48k
Plan terms
- 3 months142
- 6 months188
- 12 months71
- 24 months · special20
Good-faith estimate accuracy
Within ±10%
94%
Disputes
2
Connectors used
Stripe
requiredStatements, payment plans, good-faith estimates
Eligibility & Claims
requiredStedi / Availity
Compute patient responsibility
Microsoft Outlook
optionalStatement delivery via email
Twilio (BAA)
optionalPast-due SMS nudges