Detailed Answer
In New Jersey, a statement of account is an itemized record of charges and credits from a provider or vendor. It typically lists Charges, Adjustments, Payments, and the Balance Due. You will find insurance or government program payments in the Payments section. Providers often label this section as “Payments” or “Third-Party Payments.” These entries appear as credit amounts that reduce your outstanding balance.
Under N.J.S.A. 17:48-6, insurers must process and remit payments promptly and show payment details on patient statements. The Prompt Pay Act (N.J.S.A. 17:29B-6) also requires timely reimbursement. While N.J.A.C. 11:3-4.3 governs itemized billing for Medicaid and other government programs, statutes do not mandate a single format. Instead, transparency rules ensure you see how each payment applies to your account.
When you receive your statement:
- Locate the section titled “Payments” or “Other Insurance.”
- Find entries labeled with your insurer’s name or government program (for example, “Medicaid” or “NJ FamilyCare”).
- Match the payment date and amount against the insurer’s Explanation of Benefits (EOB).
If you notice discrepancies between your statement and the EOB, contact your provider’s billing office and your insurer. Both must correct errors under the Prompt Pay Act.
Helpful Hints
- Review your EOB before reviewing the statement to understand what your insurer paid.
- Check for common labels: “Adjustment,” “Allowance,” or “Write-Off.”
- Request an itemized breakdown if any entry looks unclear.
- Keep copies of all correspondence with your insurer and provider.
- Seek assistance from your state insurance commissioner if issues persist.
Disclaimer: This article is for informational purposes only and does not constitute legal advice.