Account Number

What is your Member ID?

Your Member ID can be found on the letter you received from us or your ID card.

If you don't know your Member ID, please enter any information that might help us identify the account.

Statement Balance

What is the balance you are paying?

Account Holder

Who is the member this payment is for?

The member name can be found on the letter you received from us or your ID card. Our letter was addressed to the member.

Payment Type

What kind of payment would you like to make?

Payment

How much would you like to pay?

Remaining Balance:

Payment Plan Setup

To set up a recurring payment plan, please call us at: 833-408-4080

Payment Method

How would you like to pay?

Pay By

Pay by Credit/Debit Card

Pay by Check

Contact Info

How can we contact you?

We require a phone number in order to contact you if we have an issue with your payment.

We require an email address in order to email a receipt to you for your records.

Review

Account
2018-IMPARK2-5817
Up-Front Payment
$215.31
Payment Schedule
Weekly payments of $50.26
Payment Method
Credit Card ************5817

By pressing the Submit button you authorize Aither Health to process the payment and/or payment plan you indicated with this payment form. You understand this authorization will remain in full force and effect until you notify Aither Health by phone or in writing that you wish to revoke this authorization. You also understand Aither Health requires at least 1 business day prior notice in order to cancel this authorization. You understand if on the day specified the funds are not available and the transaction is declined, we will attempt to process the payment for up to 3 business days after the due date unless you notify Aither Health by phone.

Refund Policy: Refunds will be made within 60 days of an overpayment.

Aither Health Address: PO Box 1408, Buffalo, NY 14226 United States of America