Hospital Billing Inquiry

You may inquire about your Alegent Health patient accounts bill by completing the form below.

Please be aware that the information you provide here can not be guaranteed to be confidential on the Internet. If you do not wish to transmit the information included in the following form electronically, please telephone the Patient Accounts Office at one of the following numbers:
Omaha Area: (402) 717-7878
Toll-free: (888) 296-9762
Fax: (402) 717-7960

NOTICE OF PRIVACY PRACTICES
The Alegent Health Notice of Privacy Practices may be accessed at this link.
In order to complete your request, you must acknowledge receipt of this notice in the form below.

Acknowledge Receipt: No Yes

* required info

Name on Account *

Patient Name *

Email Address

Street Address

Apartment or suite no.

City

State

Zip

Home phone *

Work phone

Account number

Facility where services were rendered *

Insurance co. name

Insurance co. address

Insurance policy no.

Insurance group no.

Copay amount

Your message or question *

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