Managing your Account
 
To Make A Payment
 
NEW - ASI now accepts payments online. To pay your bill securely online click HERE.
 
ASI accepts personal checks and money orders (payable to the facility where services were provided), as well as Visa, Discover and MasterCard. To make a payment, please call 410.451.2116 and select option 1 or mail your payment to:

[Name of Medical Office]
C/o Ancillary Services, Inc.
P.O. Box 6429
Annapolis, MD 21401

If you have already received a statement, you may pay with a credit card by completing the top portion of your bill.
 
Be sure to write your account number and/or the patient's name and date of birth in the memo section of your check.
 

Most medical practices will establish a payment plan for you based on hardship or special circumstances. If you are interested in setting up a payment plan, contact the facility where you were seen. They will then notify us in writing on your behalf, letting us know what payment arrangements you have made for your account.

 
To Update Insurance Information

Contact the medical office where you receive care to provide them with changes in your insurance or demographic (address, phone, etc.) information. You may also update your insurance information by completing the form provided below. *Please note that claims that are resubmitted based on incorrect or incomplete information provided at the time of service may be subject to an administrative fee.

This website is NOT secure and is NOT intended to be used for private health information. Use of this site is voluntary and for your convenience. Please contact us by phone or regular mail, as directed on your billing statement, if you need to submit private health information. Your use of this site indicates your acceptance of the Terms of Use.
 

1. Facility Where You Receive Care:
2. Patient Name:
3. Patient Date of Birth:
4. Your Phone Number:
5. Home (mailing) Address:
6. Email Address:
7. Policyholder Name:
8. Insurance Company:
9. Employer:
10. Policy ID#:
11. Group #:
12. Claims Address:(usually on back of card)


13. Comments:

 
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