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  Clinic Patient Billing Inquiry       Print
You may inquire about your Alegent Health Clinic bill by completing the form below. For billing questions related to other Alegent Health locations, please check your billing statement for an appropriate contact.

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 Central Business Office at one of the following numbers:
Omaha Area: (402) 827-4800
Toll-free: (800) 241-8173
Fax: (402) 827-4850.

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 *
Email Address
Street Address
Apartment or Suite No.
City
State
Zip
Home Phone *
Work Phone
Account Number
Insurance Co. Name
Insurance Co. Address
Insurance policy No.
Insurance group No.
Copay amount
Your message or question: *
 
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Alegent Health is a faith-based, health ministry sponsored by Catholic Health Initiatives and Immanuel Health Systems.
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