billpay.hnjh.org Open in urlscan Pro
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Form analysis
1 forms found in the DOM

POST /Account/Search

<form action="/Account/Search" autocapitalize="on" autocomplete="off" autocorrect="off" class="account-search-form" method="post" novalidate="novalidate">
  <div id="main_login" class="no-profile-login">
    <h1>Business Services Center</h1>
    <h2>Managing your hospital bill has never been easier. Use information from your statement to access your account balances, make a payment and review payment history.</h2>
    <br>
    <div class="control-group row-fluid ">
      <div class="span6 dynamic-xml-form-label">
        <label class="control-label" for="searchForm_Controls_0__Value">Enter the Responsible Party's Last Name:</label>
      </div>
      <div class="span6 dynamic-xml-form-text">
        <input data-val="true" data-val-required="*" id="searchForm_Controls_0__Value" maxlength="35" name="searchForm.Controls[0].Value" placeholder="Responsible Party's Last Name" tabindex="1" type="text" value="">
        <span class="field-validation-valid" data-valmsg-for="searchForm.Controls[0].Value" data-valmsg-replace="true"></span>
      </div>
      <input id="searchForm_Controls_0__Type" name="searchForm.Controls[0].Type" type="hidden" value="textbox">
      <input id="searchForm_Controls_0__Id" name="searchForm.Controls[0].Id" type="hidden" value="guarantorLast">
    </div>
    <div class="control-group row-fluid ">
      <div class="span6 dynamic-xml-form-label">
        <label class="control-label" for="searchForm_Controls_1__Value">Enter the Responsible Party's DOB: (MM/DD/YYYY)</label>
      </div>
      <div class="span6 dynamic-xml-form-text">
        <input data-val="true" data-val-required="*" id="searchForm_Controls_1__Value" maxlength="12" name="searchForm.Controls[1].Value" placeholder="Responsible Party's DOB" tabindex="2" type="text" value="">
        <span class="field-validation-valid" data-valmsg-for="searchForm.Controls[1].Value" data-valmsg-replace="true"></span>
      </div>
      <input id="searchForm_Controls_1__Type" name="searchForm.Controls[1].Type" type="hidden" value="textbox">
      <input id="searchForm_Controls_1__Id" name="searchForm.Controls[1].Id" type="hidden" value="guarantorDOB">
    </div>
    <div class="control-group row-fluid ">
      <div class="span6 dynamic-xml-form-label">
        <label class="control-label" for="searchForm_Controls_2__Value">Enter the Guarantor Number from your statement:</label>
      </div>
      <div class="span6 dynamic-xml-form-text">
        <input data-val="true" data-val-required="*" id="searchForm_Controls_2__Value" maxlength="50" name="searchForm.Controls[2].Value" placeholder="Guarantor Number" tabindex="3" type="text" value="">
        <span class="field-validation-valid" data-valmsg-for="searchForm.Controls[2].Value" data-valmsg-replace="true"></span>
      </div>
      <input id="searchForm_Controls_2__Type" name="searchForm.Controls[2].Type" type="hidden" value="textbox">
      <input id="searchForm_Controls_2__Id" name="searchForm.Controls[2].Id" type="hidden" value="customTransData3">
    </div>
    <div class="row-fluid">
      <div class="span12">
        <button tabindex="4" type="submit" class="btn btn-primary"><span class="account-search-next-button-text">Log In</span></button>
      </div>
    </div>
    <br>
  </div>
  <br><br>
  <div class="row-fluid">
    <div class="span10 offset1 text-center">
      <p class="top-buffer2"><span class="account-search-sub-form-text">Helen Newberry is proud of its mission to provide excellent service to all our patients and their families. We provide financial assistance based on income, family size and
          assets for medically necessary services. If payment of your medical bill is a concern, we may be able to assist you. Please contact our Customer Service Team for additional information.</span></p>
    </div>
  </div>
</form>

Text Content

WARNING!

THIS SITE REQUIRES JAVASCRIPT FOR NORMAL FUNCTIONALITY.

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Bill Pay is a third party system and is not directly connected to the Helen
Newberry Joy Hospital billing system.
If you find any discrepancies between your statement and our online bill pay
system please contact Patient Accounts at (906) 293-9115 or (906) 293-9123.



BUSINESS SERVICES CENTER


MANAGING YOUR HOSPITAL BILL HAS NEVER BEEN EASIER. USE INFORMATION FROM YOUR
STATEMENT TO ACCESS YOUR ACCOUNT BALANCES, MAKE A PAYMENT AND REVIEW PAYMENT
HISTORY.


Enter the Responsible Party's Last Name:

Enter the Responsible Party's DOB: (MM/DD/YYYY)

Enter the Guarantor Number from your statement:

Log In




Helen Newberry is proud of its mission to provide excellent service to all our
patients and their families. We provide financial assistance based on income,
family size and assets for medically necessary services. If payment of your
medical bill is a concern, we may be able to assist you. Please contact our
Customer Service Team for additional information.

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