Bill Pay Contact InformationName* First Last Phone*Email* Patient InformationName (if different than cardholder) First Last Date of Birth* MM DD YYYY Billing InformationAddress* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Amount to be applied to IHG patient account.* Total Payment $0.00 Please review amount before submitting.Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name Memo Regarding TransactionSignature*Date Date Format: MM slash DD slash YYYY Only click SUBMIT once and CLOSE THIS WINDOW FROM YOUR BROWSER once your payment has been submitted. Our vendor is working quickly to correct this glitch. If you have had a payment process more than once, are experiencing any other issues or would rather pay by phone, please contact our billing office at 317.843.9922 option 5. We sincerely apologize for any inconvenience.