Thank you for selecting Michiana Obstetrics & Gynecology for your care.  Below is some information frequently shared with our patients. Please call us at any time with any questions you may have.

There are sev­er­al ways to pay your bill

With a Duly Health and Care app account, you can now access and pay your bill, view your account details, set up your pay­ment plan, and more.

Not inter­est­ed in sign­ing up for MyChart? You can still pay online with MyChart Guest Pay. Refer to your state­ment for your Guest Pay information.

As we tran­si­tion and con­sol­i­date billing infor­ma­tion, some of the pre­vi­ous state­ments from lega­cy sys­tems will not be avail­able on MyChart. If you have received a state­ment or have a bal­ance from ser­vices before Jan­u­ary 29, 2023, please con­tin­ue to log in here to make pay­ments on lega­cy state­ments or pay­ment plans.

Billing & Finan­cial Support

Please review your billing state­ments care­ful­ly and con­tact cus­tomer ser­vice if you think there is an error, need an expla­na­tion, or need to pro­vide us with updat­ed infor­ma­tion. You can make pay­ments on your account at any clin­ic loca­tion, by email, or by call­ing 574-299-2450 to speak to one of our billing experts. They are also avail­able to answer your questions. 

Your first state­ment will be sent to you with­in 30 days after the date your ser­vice was pro­vid­ed. The state­ment will show what was billed to your insur­ance and what pay­ments are your respon­si­bil­i­ty. For your con­ve­nience, we accept most major cred­it cards, per­son­al checks, and cash. 

When you con­tact Cus­tomer Ser­vice, please have your account num­ber ready. This will help the Cus­tomer Ser­vice rep­re­sen­ta­tive access your account more quickly. 

Billing FAQs

Which meth­ods can I use to pay my bill (check, cash, cred­it card)? 

The South Bend Clin­ic accepts pay­ments made by cash, check, mon­ey order, or cred­it card. We accept the fol­low­ing cred­it cards: 

• Visa
• Mas­ter­Card
• Amer­i­can Express

Paying for Care

Michiana Obstetrics & Gynecology accepts most major insurance plans.  For questions about coverage and alternative payment arrangements please inquire by calling our office for more information.

To  Pay Your Bill  online click here - and choose the "Pay Your Bill" button for Michiana Obstetrics & Gynecology

Becoming a New Patient 

Referrals to become a patient at Michiana Obstetrics & Gynecology are not needed.  You can inquire about becoming a patient and scheduling your first visit by calling our office.  In addition, once you have scheduled your first appointment you can access our new patient paperwork electronically.  Below are forms that our practice will ask you to fill out during your visit. To help shorten your wait time, please feel free to print and fill out the forms and bring it with you completed to your first appointment.

 New Patient Forms 

Medical Record Requests 

Copies of your medical records can be requested through our Patient Portal.  If you have an account you can access the portal as described above. If you do not have access, please enroll by calling our office and asking for assistance.

Affiliations

For inpatient hospital care and surgical procedures, our physicians are available to serve you at both Memorial Hospital, Saint Joseph Regional medical Center and Allied Physicians Surgery Center.

Request­ing Med­ical Records

We have part­nered with Medicopy, a ful­ly HIPAA com­pli­ant health infor­ma­tion retrieval com­pa­ny, to ful­fill the Med­ical Records Requests of our patients. Medicopy adheres to all state and fed­er­al reg­u­la­tions con­cern­ing the release of med­ical infor­ma­tion and requires the request be in writ­ing and signed either dig­i­tal­ly or manually. 

A request to obtain copies of your med­ical record can be completed: 

Online

• Com­plete the Autho­riza­tion for Release of Health Infor­ma­tion Form

By Paper Form

• If you pre­fer to com­plete a paper autho­riza­tion form, please down­load and print the Autho­riza­tion for Release of Health Infor­ma­tion Form.
• Sub­mit your com­plet­ed paper autho­riza­tion form to Medicopy by email­ing [email protected] or by fax to 1−833−606−1226.

Please allow up to 30 days for pro­cess­ing.

Fees

Patients can request copies of their med­ical records at no cost if the deliv­ery method is via encrypt­ed email or to anoth­er provider out­side of The South Bend Clin­ic. Postage fees will apply for hard copy requests, so please ensure you sub­mit your email. If there is a fee for your request, Medicopy will pro­vide you with an invoice sum­ma­riz­ing the charges. Pay­ments can be made online https://medicopy.net/, over the phone by call­ing 1−866−587−6274 ext 215, or by mail­ing a check to the address list­ed on the invoice. All fees are in accor­dance with Indi­ana and fed­er­al law. 

Con­tin­u­a­tion of Care with oth­er Providers

All health­care facil­i­ties request­ing med­ical records must fax a request to The South Bend Clin­ic at (574) 204‑7656. Please send the patien­t’s name, date of birth, and the request­ed infor­ma­tion on your fax cov­er sheet. 

Learn more about MediCopy’s Release of Infor­ma­tion Ser­vice. If you have any ques­tions, please con­tact MediCopy: phone: 866−587−6274 | email: [email protected]