Detailed Answer
When reviewing a patient statement of account in Rhode Island, payments made by private insurers, Medicaid, Medicare, or other government programs appear in the “Payments & Adjustments” section. This section typically follows the list of billed services and associated charges. Each entry in this section shows:
- Payer Name (e.g., Blue Cross, Medicaid, Medicare)
- Payment Date
- Amount Received
- Adjustment Codes (if any)
Under Rhode Island law, health care providers must furnish an itemized statement that includes all payments from third-party payers. See R.I. Gen. Laws § 27-18.2-11, which requires disclosure of total payments and contractual write-offs. For example, if Medicare pays $150 toward an office visit, you’ll see a line such as:
12/01/2023 Medicare Payment – $150.00
This credit offsets the billed charge. After listing all payments and adjustments, the remaining patient responsibility appears at the bottom of the statement.
Providers must also include an Explanation of Benefits (EOB) or a summary of payment determinations. This requirement aligns with timely payment rules in R.I. Gen. Laws Chapter 5-37.3.
Disclaimer: This information is for educational purposes only and does not constitute legal advice. Please consult a qualified attorney or billing specialist for specific guidance.
Helpful Hints
- Locate the section labeled “Payments,” “Insurance Payments,” or “Adjustments.”
- Match payment dates with your insurer’s EOB to verify accuracy.
- Review adjustment codes—common codes include contractual write-offs and patient discounts.
- Contact your provider’s billing office if any line item seems unclear.
- Keep copies of all EOBs and insurance correspondence for your records.