Excela Health: Improving the Health and Well -being of Every Life We Touch

The costs associated with health care vary from procedure to procedure. Beyond sharing quality, safety and accessibility information, Excela Health also offers consumers information regarding the charges for these services as another means of making informed health care decisions. Individuals may have insurance deductibles, co-insurance benefits or co-pays for which they are responsible, or they may be uninsured. Either situation impacts what costs a patient may be responsible for relative to care provided.

For an estimate of out of pocket expenses related to care you expect to receive from Excela Health, please fill out the form below. You may also call us at 724-689-1850.

Patient Name:
Name of Insurance Company:
Subscriber Name:
Member ID/Group #:
Effective Date of Insurance:
Patient Date of Birth:
Diagnosis:
Ordering Physician Name and Phone Number:
Service to be Performed:
How would you like to be contacted?:	Phone - Daytime Phone - Nighttime Email
Phone - Daytime:
Phone - Nighttime:
Email:

Any personal information you provide to us including your e-mail address will be used for internal purposes only and will not be distributed or sold a third party.

	Westmoreland		No Wait
	Frick		No Wait
	Latrobe		No Wait

Call 911 if you think you have a life-threatening condition.
Information updated hourly.
Patients are seen based on severity. Times cannot be guaranteed at your arrival.