Detailed Answer
In Michigan, providers and billing entities must issue an itemized statement of account that shows all charges, payments, and adjustments. You will typically find insurance or government program payments in a section labeled “Payments,” “Payments and Adjustments,” or “Credits.” Each entry normally includes:
- Date of payment. The date the payer (insurance company or government program) processed the payment.
- Payer name. For example, the name of your health insurer, Medicare, or Medicaid.
- Payment amount. The exact dollar amount applied to your account.
- Adjustment code or description. A brief note explaining any difference between the billed charge and the payment (e.g., contractual allowance or copay).
These payments reduce your outstanding balance. For instance, if your total charges are $1,000 and your insurer pays $700, you’ll see a $700 credit in this section and a remaining balance of $300.
Under Michigan’s No-Fault Insurance Act, providers issuing periodic statements must include the amount of each payment or payment adjustment. See MCL 500.3172 for details.
How to Read It
1. Scan the top of the statement for an overview of charges.
2. Locate the “Payments and Adjustments” section midway or toward the bottom.
3. Verify each entry matches your Explanation of Benefits (EOB) from your insurer or program.
Common Payers You May See
– Private health insurers (Blue Cross Blue Shield, Aetna, etc.)
– Medicare (Part A, Part B)
– Medicaid or Michigan’s Healthy Michigan Plan
– Other government programs (Veterans Affairs, TRICARE)
Disclaimer: This article is for general information only and does not constitute legal advice. Consult a qualified attorney or billing specialist for guidance tailored to your situation.
Helpful Hints
- Keep all Explanation of Benefits (EOB) forms; they explain how your insurer processed each claim.
- Match dates and amounts on your statement to those on your EOB and Medicare Summary Notice.
- If an entry is unclear, contact the billing office and request an itemized explanation.
- Review your statement promptly—Michigan law may limit your right to dispute after a certain period.
- Retain statements and correspondence for at least three years in case of audit or dispute.