ONLINE BILL PAY

Use the form below to quickly, conveniently, and securely make your online bill payment to Columbus Regional Hospital in Columbus, Indiana.

Important Notice

This form is for payments for services received prior to July 19, 2019. All other payments should be made via MyChart. If you have questions or need an alternate payment method, please call customer service at 812-376-5315.

Go to MyChart

Online bill payment may take up to 24 hours to process. Payments are processed between the hours of 8 AM - 5 PM, Monday - Friday. If your payment is made after 5 PM, on a weekend, or on a holiday, it will not be processed until the following business day. Only one account number can be paid per transaction. Payments for more than one account must be separate transactions.

Please verify all information is correct, then click "Submit" to complete your payment.

Please correct the errors below.

Patient Information

Please enter at least 1 of the following 2 fields (Statement Number, Encounter Number)

Statement Number

Encounter Number

Please enter either the statement number or the encounter number

Patient First Name^* Please enter patient's first name

Patient Last Name^* Please enter patient's last name

Phone Number^* Please enter patient's valid phone number

Date of Birth^*mm/dd/yyyy Please enter patient's valid date of birth

Payment Information

Name on Credit Card^* Please enter name on credit card

Address 1^* Please enter address

Address 2

City^* Please enter city

State^* Please choose state

Zip^* Please enter zip

Email (this is where your receipt will be sent)^* Please enter email

Card Information

Card Type^* Please choose card type

Card Number^* Please enter card number

Expiration Date^*

Please enter expiration date

Security Code^* ex: 123 Please enter security code

Payment Amount^*

Please enter payment amount

By clicking on Continue, you will begin the payment process. You will be asked to verify that the information entered is correct, and then complete your payment submission.

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100 Years of Caring