Patient Promissory Note Program
If you are like everyone else in the Healthcare Industry your practice spends an inordinate amount of time and money collecting patient balances. Patients typically prioritize medical bills at the bottom of the list. This program changes that!
Presenting patients with an overwhelming statement balance creates a difficult situation for both the provider and the patient. With the Surepay system the provider can now present manageable installment options and schedule automatic withdrawals from the patient’s checking account or their credit & debit card. After the provider and patient agree upon the amount and frequency of each payment, Surepay will process the transactions at the designated time intervals until the patient’s account has a zero balance.
How it works:
1. Log in to our secure web page
2. Fill in the details of the payment terms (Example: Balance of $280 to be paid over 4 monthly payments of $70) as well as the patient demographic information.
3. Print out the legal Promissory Note generated by our system that holds the patient responsible to the terms of the agreement and have the patient sign it.
4. Fax it to us.
We do the rest.
All payments are automatically debited from the patient’s bank account or credit card and deposited in your account.
- We send an email reminder 1 week prior to each upcoming payment.
If a payment is returned due to insufficient funds or credit card denial, we handle the follow up.
- In the event of a default, the patient’s account can be sent to our collection agency at no cost to you!
Click on the View Presentation link below to see how easy it is to set up a patient in our Surepay Promissory Note Program. After a few keystrokes your work is done. We take over the rest of the process right through to the final payment. The system accommodates just about any financial arrangement you work out with the patient and enforces that arrangement through automated payments, email & phone communication and a backend collection agency if necessary...all at no cost to you beyond our small monthly fee. This single fee covers an unlimited number of patients on the program.
For more details or to arrange a free demo please contact us at 540-751-0084 X1234 or email us at
You may also click on the link below to download a printable brochure that explains the simplicity of the program. Applications are available for download as well.
View PowerPoint Presentation
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Download Application Form