Patient Registration Information
Billing & Payment Information
Thank you for choosing The Women’s Hospital. To help you prepare for your upcoming stay, please read the following information prior to completing your registration paperwork. If you have questions about the registration process, please call 812/842-4241
For your convenience, we have provided an online patient registration form
. We also offer the option of printing the form. Please use this registration
form if you would rather print.
You may complete the form, print it out, then mail it in (no information is transmitted)
Print the blank form, complete it and then mail it in to our offices as noted on the form.
We will make every effort to provide you with the type of accommodation you desire. The Women’s Hospital charges include nursing care, meals, permanent medical records and a variety of supporting services. This helps insure that you will have available the finest life-supporting equipment obtainable. Depending on the nature of your hospital care, you should expect additional charges for services ordered by your doctor. These may include laboratory tests, x-rays, drugs, oxygen and use of the operating room, and other items. The physician charges for his/her services and are billed to you separately.
Many changes have taken place in the health care industry in recent years. Procedures and services once covered in full may now be partially covered, covered only under certain circumstances, or in some cases not covered at all. We know that you expect to pay for services rendered by our professional staff. However, we believe it is important that you understand The Women’s Hospital’s financial arrangement procedures. If you do not know your insurance requirements, we ask that you check on your insurance coverage before returning this form.
Insurance Information -- Please be prepared to provide a copy of your health insurance card. You may also need to provide insurance forms supplied by your employer or insurance company. All patients should familiarize themselves with the terms of their insurance coverage. It is important for you to know what services your insurance does and does not cover, as any uninsured portion is the patient's responsibility.
Advance Directive -- You will be asked if you have an advance directive. This is a document you can complete to indicate your wishes about your medical treatment/health care in advance should you become unable to make those decisions. Examples of an advance directive include: Health Care Directive, Life-Prolonging Procedures Declaration, or Health Care Representative. If you have such a document, please bring a copy with you to the hospital.
All maternity patients need to contact the OB Pre-Admission Nurse for an appointment at 812/842-4170.