Accelacare Payment on Account

After submitting the payment you will receive a confirmation email; please keep this for your records. Your payment will be posted to your account within 4 business days and your balance will be reflected on the next statement. If you have any questions about your account or balance, please contact 620-271-0700.

Amount(Required)

Please input the amount you would like to pay and click on 'next' to continue.

Accelacare Payment on Account

Amount to pay:

Name

First Last

Phone

Billing Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Patient's Name (If different from payer)

First Last

Patient's Account Number(Required)

Need help locating your Account Number? Click here to view where to find it in your statement.
Please make sure that your account number is correctly inputted before submitting. If your account number is incorrectly inputted, your payment may not be correctly posted to your account.

Payment Details

American Express

Discover

MasterCard

Visa

JCB

Maestro

Card Number

Expiration Date

Security Code Cardholder Name